Bilateral cavernous nerve interposition grafting during radical retropubic prostatectomy: Memorial Sloan-Kettering Cancer Center experience.
OBJECTIVE
Cavernous nerve graft is an option for men requiring bilateral cavernous nerve resection for cancer control during radical prostatectomy. We determined the success rate and identified determinants of success of bilateral cavernous nerve grafting following resection of the 2 nerves during radical prostatectomy in patients who were potent preoperatively.


METHODS
We retrospectively reviewed the records of 44 consecutive patients who underwent bilateral nerve grafting from 1999 to 2004. Postoperative erectile function was defined as the achievement of erections satisfactory for intercourse with or without oral medication. We calculated cumulative erectile function recovery rates using Kaplan-Meier curves. The log rank test was used to compare variables affecting erectile function recovery with p <0.0083 considered significant after adjusting for the number of variables evaluated using the Bonferroni correction.


RESULTS
The overall 5-year cumulative recovery of erectile function permitting penetration was 34% and the rate of consistent penetration was 11%. None of the analyzed variables were significantly associated with recovery of postoperative erectile function, including patient age (p = 0.3), incomplete bilateral cavernous nerve resection (p = 0.045), sural nerve grafts compared to genitofemoral or ilioinguinal nerves as donor sites (p = 0.067), post-radiation salvage radical prostatectomy (p = 0.15), neoadjuvant hormone therapy (p = 0.7) and comorbidities (p = 0.15) or medications (p = 0.4) affecting EF.


CONCLUSIONS
Bilateral cavernous nerve grafts might be beneficial in select patients. A definitive answer awaits the performance of a multi-institutional, randomized, controlled trial.
Secin
Fernando P
FP
Departments of Urology and Plastic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Koppie
Theresa M
TM
Scardino
Peter T
PT
Eastham
James A
JA
Patel
Manish
M
Bianco
Fernando J
FJ
Tal
Renaan
R
Mulhall
John
J
Disa
Joseph J
JJ
Cordeiro
Peter G
PG
Rabbani
Farhang
F
D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010413:Penis / Q000294:innervation*; D010525:Peripheral Nerves / Q000637:transplantation*; D011468:Prostatectomy / Q000379:methods*; D020127:Recovery of Function; D012074:Remission Induction; D012189:Retrospective Studies