Subjective characterization of nerve sparing predicts recovery of erectile function after radical prostatectomy: defining the utility of a nerve sparing grading system.
BACKGROUND
Radical prostatectomy (RP) is a common technique for managing prostate cancer. Concern regarding functional outcomes in patients prompted the development of nerve sparing to improve recovery of erectile function.


OBJECTIVE
To assess if a cumulative nerve damage grading system is a more precise predictor of recovery of erectile function as compared to the current "all-or-none" grading system.


METHODS
Baseline demographic, medical history, and International Index of Erectile Function (IIEF)-erectile function domain (EFD) scores were collected. At the time of RP, patients were assigned a nerve sparing score (NSS) by their surgeon for each neurovascular bundle (left and right) to assess the quality of intraoperative nerve sparing (1-complete preservation, 4-complete resection). Patients completed IIEF questionnaires at 24 months after RP.


METHODS
Group comparisons and multiple regression analyses were used to test the association between the NSS and IIEF-EFD scores for patients with preoperative EFD scores ≥ 24.


RESULTS
A total of 173 patients were included in this analysis. Mean age for patients was 59, and 62% of patients had at least one comorbidity. Baseline EFD scores were comparable between all NSS assignments. At 24 months, EFD scores were reduced by 7.2, 11.6, 13.9, and 15.4 points for patients with NSS grades of 2, 3, 4, and 5-8, respectively (P < 0.01). Multivariate analysis demonstrated lower NSS predicted recovery of erectile function at 24 months (P = 0.001), as did age (P = 0.001) and baseline EFD score (P = 0.02).


CONCLUSIONS
Our data support the adoption of a subjectively assigned NSS to more precisely predict erectile function outcomes and suggest that even minor nerve trauma significantly impairs the recovery of erectile function after procedures classically regarded as having achieved bilateral nerve sparing. Further studies are needed to identify the optimal NSS system.
Moskovic
Daniel J
DJ
Urology Service, Department of Psychiatry and Behavioral Services, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Alphs
Hannah
H
Nelson
Christian J
CJ
Rabbani
Farhang
F
Eastham
James
J
Touijer
Karim
K
Guillonneau
Bertrand
B
Scardino
Peter T
PT
Mulhall
John P
JP
D007172:Erectile Dysfunction / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010410:Penile Erection; D011467:Prostate / Q000294:innervation*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012044:Regression Analysis; D014481:United States