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Les troubles sensitifs péniens. Étude clinique et électrophysiologique. À propos de 39 cas

Penile sensory disorders. A clinical and electrophysiological study of 39 cases

  • Article Original / Original Article
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Pelvi-périnéologie

Résumé

Buts

Essayer de préciser le type, les mécanismes physiopathologiques et l’étiologie des troubles sensitifs péniens. Essayer de préciser l’intérêt des explorations électrophysiologiques périnéales.

Méthodes

Trente-neuf patients consultant pour des troubles sensitifs de la verge ont été prospectivement explorés. Étaient réalisés: un examen clinique neurologique et périnéal, une exploration électrophysiologique périnéale comportant un électromyogramme des muscles bulbocaverneux, une étude du réflexe sacré, un enregistrement des potentiels évoqués corticaux du nerf pudendal, une mesure de la vitesse de conduction sensitive du nerf dorsal de la verge et dans neuf cas un enregistrement des latences terminales du nerf pudendal par stimulation endorectale.

Résultats

Les troubles sensitifs péniens à type d’anesthésie (six cas), d’hypoesthésie (29 cas) et de paresthésies (quatre cas) étaient accompagnés 14 fois d’une hypoérection s’associant à une hypo-orgasmie (six cas), à une sensation de gland froid (trois cas) et d’une perte du repérage spatial du gland pendant le rapport sexuel (deux cas). Une altération des explorations électriques a été notée 16 fois, avec toujours une perturbation d’au moins une des techniques explorant le versant sensitif (vitesse du nerf dorsal de la verge, potentiel cortical, latence distale sensitive).Vingt-trois fois les tests électrophysiologiques étaient normaux. Pour les 16 patients, la cause des troubles sensitifs a pu être déterminée: cinq compressions du nerf au cours d’une intervention orthopédique, huit étirements après trajet inhabituel en vélo, deux maladies de La Peyronie et un diabète.

Conclusion

Les neuropathies péniennes responsables de troubles sensitifs péniens sont en définitive fréquentes, retrouvées dans 40 % des cas. Répondant aux mêmes étiologies que toute atteinte nerveuse périphérique, elles sont confirmées par les explorations électrophysiologiques périnéales.

Abstract

Objective

To specify the modalities, pathophysiology, and etiology of penile sensory dysfunction. To precise the role of perineal muscles electromyography.

Methods

Thirty-nine patients with penile sensory dysfunction underwent clinical and electrophysiological testing with electromyography of perineal muscle, study of sacral reflex latencies, somatosensory cortical responses following stimulation of the dorsal nerve, sensory velocity of the dorsal nerve, and pudendal nerve terminal sensory latencies.

Results

Penile anesthesia was observed in 6 patients, loss of sensibility in 29, and paresthesia in 4. Erectile dysfunction was noted in 14 patients, hypo-orgasmia in 6, cold glans penis sensation in 3 and loss of spatial sensation during intercourse in 2. Abnormalities of electrophysiological perineal testing was observed in 16 patients. In 23 cases, no alteration of electrophysiological testing was observed. In 16 patients a specific cause was found — 5 with nerve palsy during orthopedic surgery, 8 with entrapment neuropathy following biking, 2 with Peyronie’s disease, and 1 with diabetes mellitus.

Conclusion

Neuropathy of the dorsal nerve of the penis can determine a loss of sensibility, found in 40% of the cases. This neurogenic lesion can be confirmed by means electrophysiological testing.

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Authors and Affiliations

  1. Service d’exploration périnéale et de rééducation neurologique, Hôpital Rothschild, 33 boulevard Picpus, 75012, Paris, France

    D. Verollet, S. Sheikh Ismaël, M. Fahed, P. Lacroix, F. Le Breton & G. Amarenco

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  1. D. Verollet
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  2. S. Sheikh Ismaël
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  3. M. Fahed
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  4. P. Lacroix
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  5. F. Le Breton
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  6. G. Amarenco
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Correspondence to G. Amarenco.

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Verollet, D., Ismaël, S.S., Fahed, M. et al. Les troubles sensitifs péniens. Étude clinique et électrophysiologique. À propos de 39 cas. Pelv Perineol 5, 150–154 (2010). https://doi.org/10.1007/s11608-010-0311-4

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  • DOI: https://doi.org/10.1007/s11608-010-0311-4

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