Clinical elicitation of the penilo-cavernosus reflex in circumcised men

Study Type – Aetiology (case series)Level of Evidence 4What's known on the subject? and What does the study add?It is known that foreskin, but not glans penis, contains a high density of fine-touch mechanoreceptors. Clinically the penilo-cavernosus reflex provides information on function of the sacral nerves. The study demonstrated that in the majority of circumicised men this reflex cannot be elicited clinically, but can be measured neurophysiologically. OBJECTIVE • To test clinical observations that the penilo-cavernosus reflex is much more difficult to elicit in circumcised men. PATIENTS AND METHODS • Men consecutively referred for uro-neurological or uro-neurophysiological examination were prospectively included.• Those with possible sacral neuropathic lesions were excluded.• A history was obtained, and a clinical neurological examination was performed.• The penilo-cavernosus reflex was tested clinically and neurophysiologically using electrical and mechanical stimulation.• Reflex elicitability scores in groups of circumcised men, men with foreskin retraction and a control group of uncircumcised men were compared using the Mann–Whitney U test. RESULTS • The reflex was clinically non-elicitable in 73%, 64% and 8% of 30 circumcised men, 15 men with foreskin retraction, and 29 control men, respectively.• The scored reflex elicitability was significantly (P < 0.001) higher in control men than in the other two groups clinically, but not neurophysiologically. CONCLUSION • The study confirmed the lower clinical and similar neurophysiological elicitability of the penilo-cavernosus reflex in circumcised men and in men with foreskin retraction. This finding needs to be taken into account by urologists and other clinicians in daily clinical practice.