Recovery Of Potency And Continence After Sural Nerve Graft

We showed that the cavernous nerve can regenerate after resection and interposition grafting with our initial series of bilateral SNG. The indications for bilateral non-nerve-sparing surgery, however, are rare. Almost all of the nerve graft procedures that we perform are unilateral. What are the benefits of unilateral SNG as compared to unilateral NVB resection without nerve graft? Although not randomized, our data suggest that unilateral SNG improves potency and may also improve continence.

A recent analysis of 93 patients who underwent unilateral nerve-sparing RRP (between November 1994 and November 1999) with (n=51) or without (n=42) contralateral SNG showed that 32 of the 51 men who had unilateral SNG recovered erectile function compared with 7 of the 41 men who did not have SNG. The average time to recovery of erectile function was significantly shorter in the SNG group [mean time to potency recovery 13.7 months, 95% confidence interval (CI) 11.4-15.9 months] than in the non-SNG group (mean time to potency recovery 65.9 months, 95% CI 57.7-74.1 months). Even after adjustment for age, the Kaplan-Meier probability of recovery of erectile function remained significantly higher in the SNG group than in the non-SNG group at 6, 12, 18 and 24 months (P < 0.05). The age-adjusted hazard rate when the SNG group was compared with the non-SNG group was 4.04 (P=0.003), indicating the Kaplan-Meier probability of erectile function recovery in the grafted patients was four-fold higher than that in the non-grafted patients after adjustment for age (Table 30.2). The data for this analysis were obtained from the erectile function domain score of the International Index of Erectile Function Questionnaire, or a modified 'recall' version of it. Only men with preoperative erectile function domain scores, without any therapy, of greater than 25/30 were

Table 30.2. Probability and rate of erectile function recovery after unilateral neurovascular bundle resection with or without unilateral sural nerve interposition graft (SNG).

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