The TOMAX Procedure for Penile Sensory Reconstruction in a Patient with Spina Bifida

We report the first case of penile sensory reconstruction in a patient with spina bifida in Japan. A 27-year-old man presented with congenital sensory loss in the perineal region owing to spina bifida. His myelomeningocele was repaired immediately after birth. He was unable to recognize bladder fullness and required urinary self-catheterization. Emotional erection and ejaculation were possible, and his gait was normal. We elected to perform the TOMAX procedure (i.e., TO MAXimize sensation, sexuality, and quality of life) to reconstruct penile sensation. Microsurgical sensory nerve anastomosis between the ilioinguinal nerve and the dorsal nerve of the penis was performed bilaterally under general anesthesia. No complications occurred. Penile sensation was noted 3 months after surgery. At the 1-year follow-up, the patient could detect the blue filament on Semmes-Weinstein testing. The TOMAX procedure can provide sensory recovery in patients with spina bifida and improve their quality of life.