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Sural Nerve Interposition Graft During Radical Prostatectomy

Fig. 30.7. Sural interposition graft in situ. A sural nerve segment has been used to bridge the cut ends of the excised left neurovascular bundle. The vesicourethral anastomotic sutures have not yet been tied. Reprinted from Urologie Clinics of North America 2001; 28:846 with permission from W.B. Saunders Co.

Fig. 30.7. Sural interposition graft in situ. A sural nerve segment has been used to bridge the cut ends of the excised left neurovascular bundle. The vesicourethral anastomotic sutures have not yet been tied. Reprinted from Urologie Clinics of North America 2001; 28:846 with permission from W.B. Saunders Co.

side opposite the nerve graft. We place only one Jackson-Pratt drain on the side opposite the nerve graft.

Despite the potential complications associated with sural nerve harvest, including formation of hematoma, neuroma, infection, pain, reflex sympathetic dystrophy and delayed ambulation, patients who have received an SNG typically have been able to follow our routine postoperative care pathway. They are ambulatory by postoperative day 1, and are routinely discharged home on postoperative day 2 or 3. Except for one minor leg wound infection, there have been no complications directly attributable to SNG. For the initial 4 weeks after surgery, we ask patients to wrap the ankle of the donor leg with an AceĀ® elastic bandage and to elevate it when not ambulating. These measures prevent edema and minimize discomfort.

We advise patients to use sildenafil beginning 6 weeks after surgery and to use a vacuum erection device daily as soon as continence has been restored (by 2-3 months after surgery). If patients find that erections are still inadequate for intercourse, we offer intracavernous injection therapy. Since the rate of nerve regeneration has been estimated at 1-2 mm per day in adults, patients are counseled that improved erections as a result of SNG function will not be evident until well after the sixth month post-RRP.1-3'52

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