Two-year outcome of unilateral sural nerve interposition graft after radical prostatectomy.
OBJECTIVE
To study 41 men treated for prostate cancer with unilateral nerve-sparing radical prostatectomy and contralateral sural nerve grafting from January 2000 to September 2003.


METHODS
Patients were considered for sural nerve grafting if they were considered at high risk of extracapsular extension before or during surgery, were younger than 70 years of age with good preoperative erectile function, were sexually active, and had no significant risk factors for erectile dysfunction. Potency was assessed by patient-reported questionnaires, including the International Index of Erectile Function erectile domain and Rigiscan testing.


RESULTS
The mean follow-up was 27.4 +/- 14.5 months. At 24 months, 24 (63.2%) of 38 men had erections sufficient for intercourse, with or without phosphodiesterase type 5 inhibitor use. Four men had partial erections that were occasionally satisfactory (10.5%), and 10 men reported no sexual activity, no spontaneous erections, or partial erections unsatisfactory for intercourse (26.3%). In contrast, in a group of 49 men who underwent unilateral nerve-sparing prostatectomy without nerve grafting during the same period at our institution, 13 (26.5%) had rigid erections adequate for intercourse with or without phosphodiesterase type 5 inhibitor use at 24 months of follow-up.


CONCLUSIONS
At 24 months of follow-up, men who had undergone unilateral nerve-sparing prostatectomy with contralateral sural nerve interposition graft repair of a cut cavernosal nerve had a greater rate of return of erectile function than men undergoing unilateral nerve-sparing prostatectomy alone.
Sim
Hong Gee
HG
Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Kliot
Michel
M
Lange
Paul H
PH
Ellis
William J
WJ
Takayama
Thomas K
TK
Yang
Claire C
CC
D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000502:physiology; D013497:Sural Nerve / Q000637:transplantation*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome