Bilateral cavernous nerve reconstruction during radical prostatectomy by sural nerve grafting

Erectile dysfunction after radical prostatectomy is a serious complication impairing patients' quality of life. Reconstruction of the cavernous nerve by nerve grafting was first reported by Kim in 1999 ; however, efficacy of the procedure has not been established. We analyzed the cumulative results of bilateral cavernous nerve reconstruction at our hospital. Forty-one patients who underwent bilateral cavernous nerve reconstruction by sural nerve grafting after non-nerve-sparing prostatectomy from 2005 through 2007 were included in this study. Their mean age at the time of surgery was 62.3 years. The mean follow-up period was 33.4 months. For these patients, the rates of achieving erection and sexual intercourse were investigated. Erectile function was restored in 11 patients (26.8 %) however, none could achieve sexual intercourse. No sign of erection was found in the other 30 patients (73.2 %). At first, equivalent results with the nerve-sparing technique were reported for nerve graffing; however, the results of more recent studies are worse than those of previous studies. The results of our present study were also disappointing. To evaluate the true efficacy of this technique, we must refine the inclusion criteria and select patients who are mostly likely to benefit from reconstruction. In addition, surgical devices must be modified to establish and popularize this operation.