Nerve Grafts Combat Impotency after Prostate Surgery

Nerves grafts performed during prostate cancer surgery can restore erections in men who would otherwise likely become impotent, supports the most recent data available since the procedure was pioneered at The Methodist Hospital four years ago.

For patients who had their erectile nerves on one side removed during a prostatectomy (removal of part of the prostate gland) and then underwent a nerve graft, the potency rate was significantly greater than in similar patients who did not receive grafts, said Dr. Kevin Slawin, director of the Baylor College of Medicine Prostate Center and urologist at Methodist.

If the bundles of nerves that cause erections must be cut to remove all of the cancer during a prostatectomy, the patient is usually left impotent. These erectile nerves, found on either side of the prostate gland, signal the penis to fill with blood, leading to erections. During the nerve graft procedure, a non-essential nerve called a sural nerve is removed from the ankle and used to connect the severed ends of the erectile nerves. The sural nerve serves as a guide for the regenerating erectile nerves as they re-grow over the course of a year, resuming normal function.

The study data shows that of the 51 men who underwent a unilateral (one sided) nerve-sparing prostatectomy with a sural nerve graft, 32 recovered erectile function over the course of one to two years after surgery. In contrast, of the 42 men who underwent prostate cancer surgery without a graft, only seven recovered erectile function.

At the current observed recovery rates, Dr. Slawin predicts that 71 percent of patients with a unilateral sural nerve graft will recover erectile function within 24 months while only 17 percent of the men undergoing the procedure without a graft will recover erectile function within a similar time frame.

Nerve grafting is not intended to replace nerve-sparing surgery for patients whose erectile nerves do not need to be removed because their cancer is thought to be contained entirely within the prostate. While preserving both sets of erectile nerves yields the highest potency rates, approximately one-third of the time the surgeon must remove one or both sets to completely remove the cancer.

Evidence shows that most men undergoing the sural nerve graft procedure can maintain partial spontaneous erections beginning as early as five months after having the nerve-grafting surgery and have spontaneous nighttime erections five to 12 months post operatively. Men are encouraged to pursue sexual activity as early as six weeks after surgery with assisted means, such as Viagra, injections or vacuums, in order to maintain the health of the penis. Side effects have been minimal, leaving a small patch of numbness of the skin on the side of the foot from which the graft is taken.

Each year, almost 335,000 men are diagnosed with prostate cancer and almost 50,000 undergo prostatectomies.

For more information, visit http://www.methodisthealth.com or call (713) 790-3333 for a physician referral.

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©2006 Texas Medical Center

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