Novel surgical technique offers hope of erectile function recovery in men with severe erectile dysfunction following radical prostatectomy.

Abstract

Objective: Erectile dysfunction (ED) is a common complication of non-nerve-sparing radical prostatectomy (NNSRP) and nerve-sparing radical prostatectomy (NSRP) with great impact on quality of life, and limited treatment options. We investigated the potential of an innovative surgical technique involving penile reinnervation using sural nerve grafts to restore erectile function (EF) in men with ED following NNSRP or NSRP. Method(s): Penile reinnervation was performed on 15 men with severe ED due to NNSRP or NSRP. Mean age was 63.8 +/- 3.4 years and there were no comorbidities. EF was assessed using International Index of Erectile Function (IIEF). The surgical technique involved minimally invasive harvest of both sural nerves. These were then used as nerve grafts from both femoral nerves to reinnervate the corpora cavenosa of the penis bilaterally. EF recovery and compliance/ tolerance to penile rehabilitation therapy was assessed at 6-12 and 18-30 months post-nerve grafting. All EF evaluations were performed independently. Result(s): EF recovery (IIEF >= 17) was observed in 10/13 (76.9%) of men with ED 6-12 months after nerve grafting; 3/5 (60%) NNSRP cases, 2/3 (66.7%) unilateral- NSRP cases and 5/5 (100%) bilateral- NSRP cases. Two men were excluded due to ED prior to NSRP and penile rehabilitation non-compliance. Two patients achieved spontaneous erections sufficient for penetration without any assistance. Surgery was performed in approximately 3 h. Conclusion(s): Minimally invasive penile innervation surgery using sural nerve grafts was found to successfully restore EF in 76.9% men with severe ED. This surgery offers a potentially life-changing treatment modality for ED due to NNSRP or NSRP.