Restoring erectile function with novel nerve grafting procedure after cancer

By Nicole MacKee
Australian experts have pioneered a minimally invasive nerve-grafting procedure that can restore erectile function in men with erectile dysfunction after radical prostatectomy, according to research published in European Urology.

Researchers reviewed the cases of 17 men with confirmed erectile dysfunction who underwent the novel nerve grafting procedure a median of 2.4 years after nerve-sparing radical prostatectomy and 2.2 years after non-nerve sparing prostatectomy. The men had a median age of 64 years at nerve grafting.

One year after nerve grafting, 71% of patients reported sufficient erectile function for satisfactory sexual intercourse and 94% reported significant improvement in sexual function, the researchers said.

The procedure involved microsurgical bilateral end-to-side nerve grafts from a fascicular neurotomy of the femoral nerve to the penile corpora cavernosa.

‘Six to 12 months after nerve grafting, new nerve connections are anticipated to form in the penile corpora cavernosa that release neurotransmitters to initiate the penile erectile response, and ultimately restore erectile function,’ the researchers wrote.

Associate Professor Andrew Brooks, Head of the Sydney West Area Health Service Department of Urology and Adjunct Associate Professor with the University of Sydney’s Westmead Clinical School, said the procedure seemed ‘very promising’.

‘A significant number of permanently damaged, and yet they are producing 71% results in 17 people,’ he said. ‘I think it’s very impressive.’

Associate Professor Brooks said the findings should prompt clinicians to establish projects performing this procedure to confirm the reproducibility of these results.

‘I think other [clinicians] will take it up,’ he said. ‘Let’s hope that people also publish their results to confirm the results in this relatively small study.’

Associate Professor Brooks said erectile dysfunction after radical prostatectomy was a ‘huge problem’, affecting at least half of all patients.

‘Not all of them are keen on regaining [erectile function], but there are still a lot of relatively young men who wish to retain their sexual function and suffer because of the loss of it.’
Eur Urol 2019;