UroToday - The concept of reconstituting the nerve supply to the penis with a structural graft has excited many surgeons in the field of radical prostate surgery as a feasible approach to regain erectile function in their patients after the surgery.

In this study, bilateral grafting in preoperatively potent men requiring bilateral cavernous nerve excision because of the extent of their cancer revealed only 11% consistent vaginal penetrative ability at 5 years.

Since biochemical free probability was only 33% at 5 years, it would seem that for those few men achieving any success with this therapy their likely requirement to undergo adjuvant pelvic irradiation or androgen deprivation therapy which would otherwise likely devitalize the function of the graft.

This study further sheds important light on the seemingly limited utility of this intervention.

Editor's note: For men with high volume or high grade adenocarcinoma of the prostate, wide excision including sacrifice of neural bundles is practiced. The interposition of neural tissue with peripheral nerve grafting (sural nerve) has been evaluated as an immediate interposition graft. Patients are often confused and believe that nerve grafting is an option at some time after surgery; it is not and has been performed at time of prostatectomy.
This is a very significant series since the 11% of men who were able to get penetrative erections would presumably be 0% had they not had nerve interposition. On the other hand in terms of cancer control since the surgical technique only leaves 33% biochemically free of disease at 5 years; adjuvant therapy is looking like the rule rather than the exception in this group of patients. Adjuvant radiation therapy and or hormonal castration will doubtlessly eliminate erectile ability by both damage to vascular and neural tissue and suppression of testosterone.

AUA 2006 - Abstract 1316

Reviewed by UroToday Contributing Editor Arthur Burnett

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