BJU International 2002 90 (3cr), 351CASE REPORTS
Single-incision vasectomy-induced perineal nerve damage: diagnosis by cortical evoked responses from the perineal nerve
Department of Urology, General Hospital of Polygyros, Halkidiki, Greece and * Department of Uro-Neurology, The Institute of Neurology, University College London, UK
Comment References Authors
A 47-year-old man was referred with a 3-year history of partial penile numbness, after a vasectomy through a single 1-cm long midline penoscrotal incision (Fig. 1a). The patient reported the absence of reflexogenic and morning erections but preserved psychogenic erections, decreased ejaculatory force and orgasmic ability. He had also had secondary depression and loss of sexual drive, for which he had been treated with oral antidepressants. A general neurological examination was normal but examination of the penis showed a marked loss of light touch and pinprick sensation over the penile shaft, with relative preservation of sensation over the glans penis (Fig. 1a,b). Sensation was also altered over part of the scrotal skin (Fig. 1a) but normal elsewhere on the perineum. Using a recently described technique, cortical evoked responses were recorded by stimulating the dorsal penile and perineal nerves . Although normal latencies were recorded from the responses, the amplitude of the response elicited from the perineal nerve was significantly reduced (Fig. 2), consistent with axonal loss in the territory of innervation of that nerve.
Case report References Authors
Recent neuroanatomical and neurophysiological studies have examined the distribution of the innervation of the dorsal penile nerve to the penile shaft and glans penis, and of the perineal nerve's motor and sensory components to the ventral surface of the penis, frenulum and pelvic muscles (including the bulbocavernosus) . The present patient's distribution of sensory loss, together with his decreased ejaculatory force, suggested damage to the perineal nerve resulting from the midline vasectomy incision at the penoscrotal junction.
Case report Comment Authors
Case report Comment
A.N. Apostolidis, MD, Junior Consultant Urologist.
C.J. Fowler, MSc, FRCP, Reader in Uro-Neurology.Correspondence: C.J. Fowler, The National Hospital for Neurology and Neurosurgery, Department of Uro-Neurology, Queen Square, WC1N 3BG, London, UK.
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|Apostolidis, A.N. & Fowler, C.J. Single-incision vasectomy-induced perineal nerve damage: diagnosis by cortical evoked responses from the perineal nerve.
BJU International 2002 90 (3cr), 351
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