Microsurgical bilateral end-to-side nerve grafts can restore erectile function and improve sexual quality of life in men who have undergone radical prostatectomy, according to Australian researchers.
"End-to-side nerve grafts are based on the principle of creating new nerve pathways from a donor nerve to denervated end organs when end-to-end nerve grafting is not suitable," Dr. Christopher J. Coombs of The University of Melbourne, in Parkville, and colleagues explain in European Urology, online April 4.
Their procedure, a modification of one developed by Brazilian researchers, "utilizes end-to-side nerve grafts from the femoral nerve motor fascicles only to directly reinnervate the corpora cavernosa," they note.
To evaluate this approach, the team reviewed outcomes in 17 men who underwent nerve grafting between 2015 and 2017. All had had erectile dysfunction following radical prostatectomy.
The median time between prostate surgery and nerve grafting was a little over two years, and median follow-up after grafting was 18 months.
At 12 months, erectile-function recovery sufficient for satisfactory sexual intercourse was achieved in 12 men (71%). Three of the remaining patients had intermittent erections sufficient for satisfactory intercourse after intracavernous injections, but were otherwise unable to achieve erections. There were two minor wound infections.
Overall, 94% were deemed to have clinically significant improvements in sexual function and 82% to have had reduced bother.
The team recommends end-to-side nerve grafting in clinical practice but also calls for larger studies to determine erectile function recovery rates afterward.
Dr. Fausto Viterbo of the Clinic for Plastic Surgery in Sao Paulo, Brazil, who pioneered the approach, told Reuters Health by email that a co-author of the current paper visited him in 2014 and watched the surgery.
"The main difference" between the new approach and the one he practices, Dr. Viterbo explained, is that "they use two and we used four nerve grafts."
He added, "We put two nerve grafts in the cavernous corpus and the other two nerve grafts are connected end-to-side in the dorsalis penile nerve, improving the glans sensation, decreased in many prostatectomized patients."
Overall, the outcome "seems to be reasonably impossible," Dr. Viterbo said, "but it works due to brain plasticity."
Dr. Coombs did not respond to requests for comments.
SOURCE: https://bit.ly/2GBGwOP
Eur Urol 2019.
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