Bilateral nerve graft during radical retropubic prostatectomy: 1-year followup

Purpose: With the interposition of a sural nerve graft to replace resected cavernous nerves at radical retropubic prostatectomy, we have previously re ported the return of effective erectile function. We determine the efficacy of this procedure in a series of men with at least 1-year followup. Materials and Methods: A total of 12 patent men (mean age plus or minus sta ndard deviation 57 +/- 6 years) with clinically localized prostate cancer u nderwent radical retropubic prostatectomy, with deliberate wide bilateral n eurovascular bundle resection and placement of bilateral nerve grafts. A se ries of patient and partner erectile dysfunction questionnaires, and patien t interviews were performed at 3, 6, 12 and 18 months postoperatively. Only results for those men with a followup of 12 months or greater (mean 16 +/- 4) are presented. A control group of 12 men who had undergone bilateral ne rve resection but declined nerve graft placement, was also followed. Results: Of the 12 men 4 (33%) had spontaneous medically unassisted erectio ns sufficient for sexual intercourse with vaginal penetration. An additiona l 5 (42%) men describe "40 to 60%" spontaneous erections, with fullness, no rigidity and not able to penetrate. Overall, 9 (75%) men had return of ere ctile activity. No demonstrable erections occurred before 5 months postoper atively. The greatest return of function was observed at 14 to 18 months af ter surgery. Conclusions: This surgical technique has minimal morbidity and represents a significant advance in prostate cancer surgery in men requiring bilateral nerve resection. Our study clearly demonstrates recovery of erectile functi on in men who underwent bilateral nerve graft placement during radical retr opubic prostatectomy when both cavernous nerves were deliberately resected.