Radical prostatectomy (RP) for prostate cancer treatment, although effective, can lead to severe erectile dysfunction. This study describes a new technique, which aims to reestablish the nerve stimulus in penile erection by two sural nerve graft bridges bilaterally, using the end to side neurorraphy. The first bridge is between femoral nerve and dorsal nerve of penis and the second, is between the femoral nerve and the interior of the corpus cavernosum. In this neurorraphy the endings of the newly formed fibres, generated by the femoral nerve, release acetylcholine inside the cavernous bodies, beginning the erection mechanism.
To study a novel penile reinnervation technique between the femoral nerve with the corpus cavernosum and dorsal penile nerves via sural nerve grafts by end-to-side neurorraphies.
Ten patients with a mean age of 60.3 ± 4.8 years (54 - 68) who had undergone RP at least two years previously were submitted to penile reinnervation. Four patients had undergone radiotherapy following RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire, Pharmacopenile Doppler Ultrassonography (PPDU) pre-operative and with 6, 12 and 18 months post-operative, and by a clinical evolution of erectile function (CEEF) questionnaire during 36 months.
IIEF presented improvements for erectile dysfunction, satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between right and left sides or between the allocated time periods. The introduction of nerve grafts neither cause fibrosis of the corpus cavernosum, nor reduced penile vascular flow. Regarding CEEF, sexual intercourse began after 13.7 months on average, with frequency of sexual intercourse (SI) varying from once daily to once monthly. Acute complications were minimal. This study was limited by the number of cases.
Sixty percent of cases achieved full penetration, on average, thirteen months after reinnervation surgery. One may observe that patients previously submitted to radiotherapy presented slower recuperation of erectile function. One may conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer itself as a new treatment modality for erectile dysfunction following radical prostatectomy. This article is protected by copyright. All rights reserved.
BJU international. 2017 Jan 17 [Epub ahead of print]
José Carlos Souza Trindade, Fausto Viterbo, André Petean Trindade, Wagner José Fávaro, José Carlos Souza Trindade Filho
Urology Department- Botucatu School of Medicine -State University of São Paulo - UNESP., Plastic Surgery Division - Botucatu School of Medicine -State University of São Paulo - UNESP., Radiology Division - Botucatu School of Medicine - State University of São Paulo - UNESP., Anatomy Department - Faculty of Medical Sciences - University of Campinas - UNICAMP.