Impact of unilateral interposition sural nerve grafting on recovery of urinary function after radical prostatectomy.
OBJECTIVE
To test the hypothesis that unilateral sural nerve graft (SNG) interposition may improve the rate of urinary function (UF) recovery after radical retropubic prostatectomy (RRP) in patients undergoing unilateral nerve resection (UNR).


METHODS
We studied 111 consecutive patients who underwent RRP with purposeful UNR performed by a single surgeon. Of the 111 patients, 53 underwent unilateral SNG interposition. All patients were invited to complete a questionnaire that included the validated University of California, Los Angeles, Prostate Cancer Index. The time to UF recovery above the median value of the group and urinary control status were evaluated.


RESULTS
The median follow-up was 26 and 12 months for the UNR and UNR+SNG patients, respectively. At 12 months after RRP, 94.7% of patients with UNR+SNG reported having complete urinary control or leakage of only a few drops of urine compared with 58.3% of patients with UNR alone (P = 0.012). In multivariate Cox regression models, UNR+SNG was associated with a 9.95 times greater rate of reaching a UF score above the median versus UNR alone (P <0.001). In multivariate logistic regression analyses, SNG status increased the odds of having complete urinary control or leakage of only a few drops of urine by 14.99 and 29.19 at 6 and 12 months after RRP, respectively (both P <0.05).


CONCLUSIONS
In patients undergoing UNR surgery, SNG interposition is associated with a greater rate of UF recovery and a higher likelihood of urinary control after RRP. These findings need to be validated in larger, multicenter, prospective, randomized studies.
Singh
Herb
H
Baylor Prostate Center, Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA.
Karakiewicz
Pierre
P
Shariat
Shahrokh F
SF
Canto
Eduardo I
EI
Nath
Rahul K
RK
Kattan
Michael W
MW
Slawin
Kevin M
KM
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D013497:Sural Nerve / Q000637:transplantation*; D013781:Texas; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*; D014554:Urination; D014563:Urodynamics