Interposition of sural nerve restores function of cavernous nerves resected during radical prostatectomy

Edward Kim, Peter T. Scardino, Ori Hampel, Noel L. Mills, Thomas M. Wheeler, Rahul K. Nath

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Purpose: The permanent loss of erectile function when both neurovascular bundles are widely resected at radical prostatectomy as well as the successful use of autologous nerve grafts in reconstructive surgery led us to perform bilateral nerve grafts in an effort to restore erectile function in potent patients treated for prostate cancer who underwent radical retropubic prostatectomy and resection of both neurovascular bundles. Materials and Methods: Radical retropubic prostatectomy with deliberate resection of both neurovascular bundles was recommended for high grade, locally extensive prostate cancer in 9 select, sexually active men who reported normal erectile function. After the prostate was removed but before vesicourethral anastomosis an autologous sural nerve graft was interposed between the divided ends of the cavernous nerves bilaterally. Erectile function was monitored by patient interview, questionnaire and nocturnal penile tumescence testing after the operation. Results: Four to 5 months postoperatively patients noticed slowly improving spontaneous erections, as manifested by mild tumescence regularly every several hours. Nocturnal penile tumescence testing with the RigiScan* device at 4 to 6 months in 2 cases revealed erections that approached minimal criteria for normalcy. Approximately 14 months after surgery a rigid erection sufficient for penetration and intercourse developed in 1 patient. He described this event as 'an erection of substance - hard, not just fluffy.' Conclusions: We have developed a technique using sural nerve grafts to restore continuity of the cavernous nerves, which are resected during radical prostatectomy. The early return of spontaneous partial erections in our patients suggests that interposition nerve grafts may enhance the recovery of erectile function when the neurovascular bundles are resected.

Original languageEnglish (US)
Pages (from-to)188-192
Number of pages5
JournalJournal of Urology
Volume161
Issue number1
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

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Sural Nerve
Prostatectomy
Transplants
Penile Erection
Prostatic Neoplasms
Reconstructive Surgical Procedures
Recovery of Function
Prostate
Interviews
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Interposition of sural nerve restores function of cavernous nerves resected during radical prostatectomy. / Kim, Edward; Scardino, Peter T.; Hampel, Ori; Mills, Noel L.; Wheeler, Thomas M.; Nath, Rahul K.

In: Journal of Urology, Vol. 161, No. 1, 01.01.1999, p. 188-192.

Research output: Contribution to journalArticle

Kim, Edward ; Scardino, Peter T. ; Hampel, Ori ; Mills, Noel L. ; Wheeler, Thomas M. ; Nath, Rahul K. / Interposition of sural nerve restores function of cavernous nerves resected during radical prostatectomy. In: Journal of Urology. 1999 ; Vol. 161, No. 1. pp. 188-192.
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