MP32-03 ERECTILE FUNCTION RESTORATION POST-RADICAL PROSTATECTOMY: UTILISATION OF A NEW NOVEL END-TO-SIDE NERVE GRAFTING PROCEDURE

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II1 Apr 2018MP32-03 ERECTILE FUNCTION RESTORATION POST-RADICAL PROSTATECTOMY: UTILISATION OF A NEW NOVEL END-TO-SIDE NERVE GRAFTING PROCEDURE Christopher Coombs, Jeanette Reece, and David Dangerfield Christopher CoombsChristopher Coombs More articles by this author , Jeanette ReeceJeanette Reece More articles by this author , and David DangerfieldDavid Dangerfield More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1053AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Permanent erectile dysfunction (ED) is a common adverse side effect of radical prostatectomy (RP) that can significantly impact on health-related quality of life (HRQOL). We investigated the potential of our novel end-to-side sural nerve grafting technique to restore erectile function (EF) and improve HRQOL in a cohort of 11 men with permanent ED following RP. METHODS Eleven patients aged 58-70 years with moderate to severe ED, at least 2 years after nerve-sparing RP or 6 months after non-nerve-sparing RP, were candidates for novel nerve graft surgery to restore EF. The minimally invasive surgical technique involved two single bilateral end-to-side somatic-to-autonomic sural nerve grafts from the donor femoral nerve to the corpora cavernosa of the penis. EF outcomes were measured using the International Index of Erectile Function (IIEF5) and HRQOL outcomes were measured using the sexual domain of the Expanded Prostate Cancer Index Composite for clinical practice (EPIC-CP). Outcomes were assessed pre-RP, pre-nerve grafting and at 3-6 month intervals for 12-30 months following nerve grafting. All assessments were performed independently of the treating surgeons. RESULTS Pre-RP, all men had satisfactory EF (IIEF5 ≥ 17). Pre-nerve grafting, all men had ED insufficient to achieve and maintain sexual penetration (IIEF5 ≤ 11). Post-nerve grafting, EF recovery (IIEF5 ≥ 17) was observed in 9/11 (82%) men with confirmed ED following RP (3/4 men after non-nerve-sparing RP; 3/4 men after bilateral nerve-sparing RP and 3/3 men after unilateral nerve-sparing RP). EF recovery was observed in 4 men 6 months following nerve grafting and in 5 men 12 months following nerve grafting. Significant improvements in post-nerve grafting HRQOL summary, function and bother scores compared with pre-nerve grafting scores were observed in men with restored EF. Three patients could maintain spontaneous erections sufficient for sexual penetration without any penile rehabilitation therapy 12 months post-nerve grafting. Surgeries were performed in around 2.5 hours, followed by an overnight stay in hospital. There was one acute postoperative wound infection. CONCLUSIONS Our innovative end-to-side sural nerve grafting procedure offers a feasible treatment modality to restore EF in impotent men following nerve- or non-nerve sparing RP. EF restoration sufficient to achieve and maintain sexual penetration was observed in 82% of patients where prior to nerve grafting, the likelihood of EF recovery for these men was almost negligible. This minimally invasive nerve grafting technique also has the potential to significantly improve HRQOL. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e420-e421 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christopher Coombs More articles by this author Jeanette Reece More articles by this author David Dangerfield More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...