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Treatment of Erectile Dysfunction Post Radical Prostatectomy by Nerve Grafts and End-To-Side Neurorraphy
Fausto Viterbo, PhD, José Carlos Souza Trindade, Full, Professor, José Carlos Souza Trindade Filho, PhD, André Petean Trindade, PhD and Wagner José Fávaro, PhD
Plastic Surgery Division, Unesp, Botucatu, Brazil
INTRODUCTION: The radical prostatectomy (RP) for the prostate cancer treatment, although effective in the treatment of this neoplasia, can led to severe erectile dysfunction, resultant of the periprostatic nerve plexus injury, what compromises life quality. To reestablish the nerve stimulus we developed a technique of penile reinnervation through sural nerve bridges between the femoral nerve (donor nerve fibers) and the penile dorsal nerve and the cavernosum corpus (receptors). METHOD: From March 2011 to March 2013, 10 patients with 61 years old ± 5 (55-69), with severe erectile dysfunction post RP were submitted to penile reinnervation. The interval between surgeries were 48 ± 34 (26 to 137) months. These patients use to have satisfactory sexual activities before the RP. In 80% of the patients there was at least one comorbidity: radiotherapy post RP (40%), hypertension (30%), depression using medication (20%). No patient was able to maintain natural penetration or with the use of phosphodiesterase-5 inhibitor post RP. The surgery consisted in four sural nerve grafts, in bridges, two in each side, and all with one of the extremities sutured to the side of the femoral nerves, bellow the inguinal ligament. An epi-perineural femoral nerve window was removed. One of the grafts from each side was sutured in the lateral face of the penile dorsal nerve and another graft, from each side, was placed into the proximal portion of the cavernous corpus (neurotization). The exposition of the base of the penis was made through a semicircular incision at the pubic region. RESULTS: From the 4 patients with at least 12 months post penile reinnervation, 1 (25%) showed satisfactory sexual activities with penetration after 6 months post-op, and 3 (75%) after 12 months. The Initial International Index of Erectile Function (IIEF) was 21 ± 11 in the pre-operative and increased to 40 ± 20 (6 months), 55 ±14 (12 months) and 63 ± 2 (18 months). Comparing the intervals, (0, 6 e 12 months) we can observe a significant difference (p = 0.0038). CONCLUSION: The new technique of penile reinnervation is a promising alternative to the invasive traditional methods for the treatment of the erectile dysfunction post RP. The average period for satisfactory results was of 12 months.
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