Primary Surgery

In 1997, autologous sural nerve grafting to reconstruct bilaterally resected cavernosal nerves was successfully performed in patients undergoing radical retropubic prostatectomy. After 12 months, one third of these patients had erections sufficient for intercourse. Since that time, patients who have had neurovascular bundle resection and sural nerve grafting have continued to show promising results.

For example, within one large cohort of men who had unilateral, nerve-sparing radical prostatectomy, significantly more men who had sural nerve grafting regained potency, and did so in less time, than men who did not have grafting.

More importantly, however, with better predictions of the presence of extracapsular disease, nerve-sparing surgery can be performed more selectively, reserving wide resection and sural nerve grafting for patients likely to have extracapsular extension. A multicenter, randomized clinical trial is needed to substantiate the positive outcomes observed with sural nerve grafting.

Sural Nerve Grafting Procedure

In patients that receive a SNG, the predicted time to recovery of function is somewhat longer than 1 year. The reason for this is that the rate of peripheral nerve regeneration is, on average, about 1 mm per day, and a nerve regeneration must traverse not only through the nerve graft, which typically measures 6.5 cm in length, but also the distal in situ segment, which is about 8 to 10 cm in length.

Individual patient variables, however, may significantly prolong or reduce this time. Patient morbidity has been minimal, consisting primarily of an area of numbness at the lateral aspect of the foot. With experience, the added time to the procedure now averages only ~10 minutes. A trained microsurgeon such as Doctor Nath has performed over 2,500 nerve grafts in his career. This uniquely large experience allows better outcomes and fewer complications.