Men with higher stage prostate cancer may benefit from sural nerve grafting when undergoing open radical prostatectomy, according to new research published in The Journal of Sexual Medicine.
The research team, which included scientists from Canada, Pakistan, and Saudi Arabia, recommended a multidisciplinary approach, with a plastic surgeon conducting the graft contemporaneously with the prostatectomy procedure.
Often, patients who undergo open radical prostatectomy develop erectile dysfunction because of damage to neurovascular bundles. Grafting a portion of the sural nerve, taken from the leg, is one way to restore erectile function for some men. However, past research on the effectiveness of this procedure has shown mixed results.
In this study, the researchers examined the outcomes of 66 men with localized prostate cancer. All of the men had open radical prostatectomies performed by the same surgeon. A section of the sural nerve was harvested by a plastic surgeon and grafted in place during the same surgical session. About two-thirds of the men had unilateral sural nerve grafting procedures; the rest had bilateral procedures.
The International Index of Erectile Function (IIEF) was used to assess the men’s erections before surgery and at various intervals during the follow-up period. The mean follow-up duration was 35 months. An IIEF score above 22 was used to designate erectile recovery.
Before surgery, the men’s mean IIEF score was 23.4 ± 1.6. Afterward, about 29% of the patients had “preservation of potency,” with IIEF scores above 22. Patients under age 60 tended to have better function.
The men were encouraged to take phosphodiesterase type 5 (PDE5) inhibitors to help with their erections, but this was not an official study protocol. Sixty-percent of the men followed this advice and tended to have better erectile recovery than the men who did not take PED5 inhibitors.
The authors also noted that their approach – involving a plastic surgeon to contemporaneously harvest the sural nerve – did not take more time than a typical radical prostatectomy procedure. Their mean time was 164 minutes; a typical procedure takes about 165 minutes, they said.
They added that their technique could work for laparoscopic robot-assisted procedures, although it would be “logistically more challenging.”
The study was first published online in June in The Journal of Sexual Medicine.
The Journal of Sexual Medicine
Siddiqui, Khurram M., FRCS, et al.
“Three-Year Outcomes of Recovery of Erectile Function after Open Radical Prostatectomy with Sural Nerve Grafting”
(Full-text. First published online: June 5, 2014)