Recovery Of Erectile Function After Unilateral And Bilateral Cavernous Nerve Interposition Grafting During Radical Pelvic Surgery

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Prostate / Prostate Cancer;  Urology / Nephrology
Article Date: 26 Apr 2009 - 3:00 PDT

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UroToday.com - The concept behind nerve grafting is to make use of one's own nerves, which play a minimal functional role, as conduits to promote the regrowth of new nerve fibers. In certain patients with prostate cancer, the nerves crucial for erectile function (cavernous nerves) may need to be cut in the interest of removing high-risk cancer. In these situations, the genitofemoral nerve can be interposed (grafted) as a conduit to promote regrowth of new nerve fibers. Our study examined the feasibility and success of this in patients with prostate cancer as well as those with bladder cancer, in which the prostate is also removed.

Although ours was a relatively small study, its strength lies in that we used a person independent from the surgeon who performed the surgery to assess patients on their outcomes. We found detectable rates of erectile potency in 38% of patients with a single bundle of nerves cut then grafted compared to 30% when both nerve bundles are cut and grafted. It is important to keep in mind that these patients may or may not have been using a medication that assists in erectile function such as Viagara®, Cialis® or Levitra®.

The important direction from this study is the attention it has drawn for the need to conduct a larger, randomized-controlled study to make final conclusions. Nevertheless, the study has reiterated that Urologic surgeons can perform this procedure. We recommend that the option for cavernous nerve interposition grafting should be discussed with select patients including those undergoing surgery for bladder cancer.

Written by Raj Satkunasivam, Sree Appu, Rami Al-Azab, Karen Hersey, Gina Lockwood, Joan Lipa and Neil E. Fleshner as part of Beyond the Abstract on UroToday.com

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