Abstract: New Treatment of Erectile Dysfunction Post-Radical Prostatectomy Using Nerve Grafts and End-to-Side Neurorraphies

Abstract

INTRODUCTION: Radical prostatectomy (RP) for prostate cancer treatment, although effective, can lead to severe erectile dysfunction. This study describes a new technique, which aims to reestablish the nerve stimulus in penile erection via two sural nerve graft bridges, bilaterally. OBJECTIVE: To study a novel penile reinnervation technique between the femoral and cavernous corpus and dorsal penile nerves via sural nerve grafts and end-to-side neurorraphies. METHODS: Ten patients with a mean age of 60.3 ± 4.8 years (54 – 68) who had undergone RP at least two years previously were submitted to penile reinnervation. Four patients had undergone radiotherapy following RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire, Pharmacopenile Doppler Ultrassonography (PPDU) at pre-op, 6, 12 and 18 months post-op, and by a clinical evolution of erectile function (CEEF) questionnaire during 36 months. RESULTS: IIEF presented improvements for erectile dysfunction, satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between right and left sides or between the allocated time periods. The introduction of nerve grafts did not cause fibrosis of the corpus cavernosum, nor did it lead to a reduced penile vascular flow. Regarding CEEF, sexual intercourse began after 13.7 months, with frequency of sexual intercourse (SI) varying from once daily to once monthly. CONCLUSION: Sixty percent of cases achieved full penetration, on average, thirteen months after reinnervation surgery. One may observe that patients previously submitted to radiotherapy presented slower recuperation of erectile function. One may conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer itself as a new treatment modality for erectile dysfunction following radical prostatectomy.