Back to 2025 Abstracts
Efficacy Of Polyethylene-glycol (peg) On Nerve Recovery Following Phalloplasty: A Double-blind Randomized Clinical Trial
Ronald Max-Edouard Cornely, MPH, Barite Gutama, MD, Sriya Nemani, BA, Ricardo A. Torres-Guzman, MD, Abbott N. Abbott, BA, Anvith P. Reddy, MS, Benjamin Savitz, BS, Noah Alter, BS, Salam Kassis, MD, Wesley P. Thayer, MD, PhD, Patrick E. Assi, MD.
Vanderbilt University Medical Center, Nashville, TN, USA.
PURPOSE: Phalloplasty, a genitourinary surgery for transmasculine patients, constructs a neophallus using free or muscle flaps. While sensory restoration, particularly tactile, erogenous, and protective sensation, is a top priority for patients, standard nerve coaptations in phalloplasty often fail to achieve adequate sensory recovery due to limited nerve regeneration. Our previous animal and human studies showed promising results with polyethylene-glycol (PEG) use in nerve coaptation, aiming to enhance nerve repair by limiting Wallerian degeneration and immediately restoring axonal continuity. This study evaluates whether PEG-assisted nerve coaptation improves sensory outcomes following phalloplasty compared to standard neurorrhaphy.
METHODS: Patients undergoing radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap phalloplasty were randomized into control (standard coaptation) and PEG cohorts (PEG-assisted coaptation) using block randomization. Both patients and study personnel were blinded to treatment allocation. Sensory recovery in the neophallus was assessed at 1, 3, and 5 weeks post-surgery using Semmes-Weinstein monofilament (SWMF) testing across four quadrants, with sensory differences analyzed between cohorts.
RESULTS:
A total of 32 penile shaft quadrants across 8 patients were analyzed. PEG-treated patients showed significantly improved sensory scores in quadrants 2 (p=0.019) and 3 (p=0.022), as well as across all quadrants combined (p=0.040), compared to controls. No adverse drug-related events were reported.
CONCLUSION: PEG-assisted nerve coaptation is safe and significantly enhances early sensory recovery in phalloplasty, potentially offering a valuable technique for sensory improvement in gender-affirming surgery.
Back to 2025 Abstracts