Open Access

ARTICLE

Erectile function following unilateral cavernosal nerve replacement

Gregory R. Hanson, Lester S. Borden, Jr., Doug D. Backous, Stephen W. Bayles, John M. Corman

Section of Urology, Virginia Mason Medical Center, Seattle, Washington, USA
Address correspondence to Dr. John M. Corman, Section of Urology, Virginia Mason Medical Center, C7-URO, 1100 9^th Avenue, Seattle, WA 98101 USA

Canadian Journal of Urology 2008, 15(2), 3990-3993.

Abstract

Introduction: With nerve-sparing techniques, patients undergoing a radical prostatectomy may avoid the morbidity of erectile dysfunction. Certain patients who are not candidates for nerve-sparing procedures may be eligible for nerve interposition grafts. While bilateral cavernosal nerve grafting after radical prostatectomy has shown efficacy, the effect of unilateral nerve grafting following prostatectomy remains unclear. We evaluate a large group of patients who underwent a unilateral cavernosal nerve replacement.
Methods: Forty patients underwent unilateral nerve sparing surgery with concomitant contralateral cavernosal nerve replacement. Patients were selected for this procedure based upon preoperative nomogram risk assessment, endorectal MRI evidence of extra capsular disease (ECE) or intraoperative histology demonstrating margin positivity. Age, demographic data, Gleason score, bundles (NVB) are spared. When only one NVB is spared, potency rates decrease to 30%-50%.5,6 Loss of potency results in a clear reduction in quality of life.7 Even though there are options to treat sexual dysfunction in the postoperative patient, maintaining spontaneous erections remains the goal. Recently, there has been renewed interest in cavernosal nerve grafting to increase potency after one or both neurovascular bundles have been resected at the time of radical prostatectomy.8,9
Methods: Forty patients underwent open radical retropubic prostatectomy with unilateral nerve cavernosal nerve replacement by a single surgeon (JMC) from January 2003 to December 2006. All patients underwent a unilateral neurovascular bundle resection based on 3990 clinical and pathologic stage and pre and post operative IIEF data was collected and prospectively analyzed.
Results: Median follow-up was 19 months. Median change in IIEF scores was 7.5. Twenty-one of 29 patients (72%) report being able to penetrate after prostatectomy. Sixteen of those 21 (76%) continue to require PDE-5 inhibitors to facilitate penetration. Four of the 6 patients (67%) who were unable to have intercourse following cavernosal nerve replacement received adjuvant hormonal and/or radiation therapy. Twenty-eight patients (97%) reported numbness at the graft harvest site. One patient experienced a graft site infection. Two of 29 (7%) patients reported pain at the harvest site.
Conclusion: Unilateral sural nerve grafting is a feasible and well-tolerated approach for patients who must undergo wide resection of a NVB. While men do show a decrease in their IIEF score, 76% are able to achieve penetration following surgery. The majority of men continue to require PDE-5 inhibitors to facilitate intercourse.

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