|Overgoor et al. 2015;
|Population: 30 low spinal lesion (T12
(incomplete) to sacral) patients (mean
age=29.5 years, range=13-59 years), 13
with spina bifida and 17 with a spinal cord
Treatment: Researchers wanted to test
whether self-report of reflex erections (RE)
or bulbocavernosus reflex (BCR) testing
was sufficient to determine whether patients
should have unilateral or bilateral (surgery)
to maximize sexual function.
Outcome Measures: The integrity of the
sacral-reflex-arc and DNP function was
tested pre-operatively using bilateral
needle electromyography (EMG)–
bulbocavernosus reflex (BCR)
measurements, and an interview about
reflex erections (RE) ability.
|1. Neither Self-report of RE nor BCR
testing can independently predict which
surgery protocol should be used (7
patients reported RE, 4 of which had
positive bilateral BCR; 9 patients had
positive BCR, 4 of which had RE.)
2. No significant association between
BCR function and RE.
|Overgoor et al. 2014
|Population: 40 low-spinal lesion men with
no penile but intact groin sensationMethodology: The “TOMAX” (TO MAXimize sensation, sexuality, and quality of
life) procedure restores genital sensation in
men with low spinal lesions, improving
sexual health, as shown previously. It
connects the dorsal nerve of the penis to
the intact ipsilateral ilioinguinal nerve,
unilaterally or bilaterally. This study reports
on the technical aspects based on 43
TOMAX nerve transfers. 43 nerve transfers
were performed on the participants.Outcome Measures: Data on patient
selection, surgical history, anatomy of the
ilioinguinal nerve and dorsal nerve of the
penis, unilateral or bilateral surgery, surgical
technique, complications, and patient
information were collected prospectively.
|1. Regardless of origin, all patients with
no penile but good groin sensation are
eligible for the procedure, provided the
ilioinguinal nerve is not damaged
because of former inguinal surgery or
absent because of anatomical
2. Selection of a unilateral or bilateral
procedure depends on the presence
or absence of reflex erections and
3. Preliminary experience with the first
three bilateral cases shows that it is
technically feasible, with encouraging
results. The surgical technique has
evolved (described in detail, including
video) to enhance outcome and
4. The TOMAX procedure can then be
used to restore erogenous penile
sensation and improve the quality of
sexual health in patients with absent
penile but good groin sensation.
|Kim et al. 2008;
|Population: 48 participants with SCI and
erectile dysfunction, mean age 58.9 (range
Treatment: malleable penile prosthesis
Outcome Measures: Subjective
satisfaction questionnaire; possibility of
|1. 38 (79.2%) of the participants reported
some degree of satisfaction with their
2. Intercourse was possible in 44
3. Complications occurred in 8
participants: 4 had infections, 2 had
erosion towards the urethra and glans,
1 experienced pain due to the insertion
of an overly large prosthesis, and 1 was
dissatisfied with the small size of the
|Zermann et al. 2006;
|Population: Men with neurological
impairment, n=197 with SCI; Age: mean
40.8 yrs, range 17-75; Injury level:
paraplegia (n=188), tetraplegia (n=57);
Diagnostic groups: urinary management
(n=134), erectile dysfunction (ED) (n=60),urinary management and ED (n=51).
Treatment: Penile prosthesis: semirigid
Jonas (n=147), self-contained inflatable
AMS Hydroflex or AMS Dynaflex (n=113),
and inflatable 3-piece AMS 700 CX (n=33).
Outcome Measures: Sexual intercourse
success, treatment satisfaction, secure
condom fixation, urinary management,
|1. Sexual intercourse was possible in
83.7% of individuals with penile
prosthesis for ED.
2. 67% of female were satisfied with
result of their partner’s treatment.
3. Adverse events: infection rate 5%,
perforation rate 18.1% (semi-rigid
Jonas), 2.4% (self-contained inflatable
Dynaflex), and 0% (inflatable 3-piece
AMS 700), respectively.
|Gross et al. 1996;
|Population: Men with SCI; Age: mean
39.9 yrs, range 16-72; Injury level:
paraplegia (n=128), tetraplegia (n=38);
Impairment: erectile dysfunction (n=49),
penile retraction (n=113), both (n=47).
Treatment: Penile prosthesis.
Outcome measures: Use of prosthesis,
satisfaction with sexual intercourse,
|1. Use of prosthesis: 83 out of 96 men
with ED used prosthesis at 5 yrs after
2. Satisfactory sexual intercourse was
reported by 84% of men with ED.
3. Adverse events: perforation in 7% of
men: 9.4% occurred with semi-rigid
prosthesis vs 2.7% of semi-flexible
prosthesis, infection in 5.6% leading to
removal of prosthesis.
|Collins & Hackler 1988;
|Population: 63 men with SCI.
Treatment: Penile implantation of semirigid device or Mentor inflatable prosthesis.
Outcome Measures: Penile implantation
|1. 53 patients with a semi-rigid implant,
44 currently have functional prosthesis
(83% overall success rate).
2. 10 patients received inflatable penile
prostheses: 4 were lost, 2 had
3. Overall complication rate in the 63
patients=33% (lost prosthesis).
4. After reimplantation, 52/63 patients
had functional device, resulting in 82%
ultimate success rate.
|Iwatsubo et al. 1986;
|Population: Men with SCI, Age: mean 42
yrs, range 21-63, Injury level: tetraplegia
(n=10), paraplegia (n=23), cauda equina
Treatment: Shirai-type silicone implants;
follow up from 6-46 months.
Outcome measures: Impact on sexual
function, adverse events.
|1. Impact on sexual function: 15 (41%)
men reported improvement, 18 (48%)
men reported no sexual benefit, 4
(11%) men were dissatisfied.
2. Adverse events: extrusion of
prosthesis due to infection (n=2) and
removal due to causalgia in LE (n=1),
posterior migration of prosthesis (n=1).
|Green & Sloan 1986;
|Population: 40 men; Age range: 21-60
yrs, Impairment grade: AIS A (n=31), B-D
Treatment: Penile prosthesis.
Outcome Measures: Sexual
|1. 31 patients have intercourse regularly
and pleased with decision to have
2. 4 patients dissatisfied all had semirigid implant.