PURPOSE: Prostate adenocarcinoma is the most common non-skin cancer in American males. Localized prostate cancer can be treated by radical prostatectomy (RP) or radiation therapy. Impotence is a common side effect of either treatment that can decrease patient quality of life and cause patients to delay or decline treatment. We present evidence that unilateral cavernous nerve reconstruction with an interposition sural nerve graft increases the rate of sexual potency following unilateral nerve sparing RP.

BACKGROUND: Impotence following RP can result from injury to, or resection of, the cavernous nerves. These are the parasympathetic nerves that originate from sacral nerve roots, and are necessary for normal penile erection. These nerves travel with the vascular bundle on either side of the prostate to the penis. The cavernous nerves are a loose collection of nerve fibers which are not easily visible to the naked eye. One or both neurovascular bundles, with their associated cavernous nerves, are often resected during RP to ensure complete tumor resection and negative surgical margins.

METHODS: We retrospectively reviewed the records of all patients who underwent unilateral sural nerve graft repair of the cavernous nerves following RP at our institution from March 1999 through November 2002. Erectile activity and sexual function were assessed by patient report at the time of follow-up. Rates of potency of the study group were compared to historical controls. Potency is defined as the ability to have spontaneous erections sufficient for vaginal penetration.

RESULTS: 100 unilateral cavernous nerve reconstructions were performed during the study period. Of the 21 patients with 12 or more months of follow-up, 13 (62%) were potent. Of the 40 patients with 6 to 12 months follow-up, 19 (48%) were potent. Published rates of potency following unilateral nerve sparing RP without nerve graft reconstruction average approximately 32%

CONCLUSIONS: Sural nerve graft repair of unilateral cavernous nerve defects increases recovery of sexual potency following unilateral nerve sparing radical prostatectomy.