Anatomy of the Injury

Sural nerve grafting (SNG) in patients who have undergone deliberate excision of one or both neurovascular bundles (NVBs) during radical retropubic prostatectomy (RRP) has generated intense interest, and has been statistically proven in many studies. Currently over 30 centers worldwide are performing sural nerve grafts, although Dr. Nath was one of the first surgeons and still the most experienced with the best published results. Over 1,000 patients worldwide have undergone sural nerve grafting after prostatectomy.

Preclinical results of experiments in animal models supported the feasibility of such an approach.

For example, rat studies had demonstrated that genitofemoral interposition nerve grafting could restore cavernous nerve function after 5-mm sections of the cavernous nerves were excised bilaterally. In 1997, Doctor Nath performed the first successful sural nerve graft for potency following radical prostatectomy. Since then he has performed over 650 such grafts with an overall success rate approaching 80%. This contrasts sharply with a potency rate of between 0% and 18% in untreated patients.