Predictors of recovery of erectile function after unilateral cavernous nerve graft reconstruction at radical retropubic prostatectomy.
BACKGROUND
Although studies have reported a benefit to bilateral cavernous nerve graft (NG) interposition, the role of unilateral NG interposition in recovery of erectile function (EF) after radical prostatectomy (RP) with unilateral neurovascular bundle (NVB) resection is more controversial.


OBJECTIVE
To determine the probability and predictors of EF recovery after unilateral cavernous NG at RP with unilateral NVB resection.


METHODS
We retrospectively reviewed the records of preoperatively potent men who underwent RP with unilateral NVB resection and ipsilateral NG without prior radiation or hormonal therapy from 1999 to 2007. Postoperative EF was defined in two ways: (i) physician interview-based assessment (level 3: erections sometimes sufficient for intercourse; level 2: erections routinely sufficient for intercourse; level 1: normal erections; all with or without oral phosphodiesterase-5 inhibitor use); and (ii) according to the sum Q3 + Q4 on the International Index of Erectile Function (IIEF) questionnaire.


METHODS
EF recovery based on physician interview-based scale and IIEF questionnaire.


RESULTS
In all, 131 men underwent unilateral NG. Median follow-up was 37.3 months. The 5-year actuarial probability of EF recovery was 46, 30, and 12% for levels 3, 2, and 1, respectively, and 40, 34, and 22% for IIEF Q3 + Q4 sum > or =6, > or =8, and = 10, respectively. On multivariate analysis, patient age, specimen weight, and plastic surgeon were predictive of EF recovery based on physician-interview whereas patient age, ethnicity, and plastic surgeon were predictive of EF recovery based on the IIEF questionnaire.


CONCLUSIONS
The impact of plastic surgeon on EF recovery with unilateral NG would suggest that technical factors play a role in EF recovery after unilateral NG. Meticulous surgical technique with proper identification of proximal and distal recipient nerve endings may improve the chance of EF recovery. The variation in recovery rate among plastic surgeons would imply that there is a benefit to unilateral NG in EF recovery.
Rabbani
Farhang
F
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. rabbanif@mskcc.org
Ramasamy
Ranjith
R
Patel
Manish I
MI
Cozzi
Paul
P
Disa
Joseph J
JJ
Cordeiro
Peter G
PG
Mehrara
Babak J
BJ
Eastham
James A
JA
Scardino
Peter T
PT
Mulhall
John P
JP
D003131:Combined Modality Therapy; D007172:Erectile Dysfunction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016067:Nerve Transfer / Q000379:methods*; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome