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A new nerve grafting technique provides hope for men with impotence after
radical prostatectomy.
With the earlier detection of prostate cancer, quality of life issues are becoming
more important. Development of erectile dysfunction (ED) following radical therapy
occurs in the majority of the patients treated by radical prostatectomy.
It is assumed that the ED relates to damage to the nerves subserving erection.
According to a research published recently on the journal Urology, a nerve grafting
technique provides new hope for men with impotence after radical prostatectomy.
According to the research, thanks of the nerve grafting technique, four of 12 men
regained all or most of their ability to have a spontaneous, medically unassisted
erection adequate for intercourse, 12 to 28 months after surgery.
In addition, another three men were able to have sexual intercourse, achieving
erections by the use of Viagra (sildenafil).
For the graft is used the sural nerve which runs down the back of the leg.
According to one of the study authors, Edward D. Kim, MD at the University of
Tennessee Medical Center, the removal of the cavernous nerves, that are located
on either side of the prostate gland, is the main cause of postoperative impotence.
When both cavernous nerves are removed, impotence occurs in almost all patients.
Sural nerve grafting has as a goal to resolve the impotence problem while still
optimising cancer control. This technique can only be performed at the time of the
prostatectomy.
A plastic surgeon and an urologist work together to do it.
This technique could have as a result numbness in an area about the size of a half
dollar on the outside of the ankle. We can easily understand that for most men, if
they have to choose from impotence or numbness in their foot, the choice is quite
easy.
According to the authors of the research, the doctor should begin therapy to help
the patient achieve erections as soon as four to six weeks after surgery. Drugs can
be delivered orally -sildenafil (Viagra)-, or by penile injections- papaverine,
prostaglandin E1, and phenotolamine (Trimix)- or transurethrally. It can also be
used a vacuum erection device. We should remind of course that the cardiovascular
status of the patient and his overall fitness for renewed sexual activity must be
assessed before treatment for erectile dysfunction is initiated. The efficacy of
sildenafil is related to the extent and severity of erectile dysfunction, and is
significantly reduced in patients with severe vasculogenic erectile dysfunction.
The research suggests that therapy should begin as soon as possible after
surgery, so as to improve a patient's chances of achieving spontaneous erections.
According to Dr. Kim the sural nerve graft offers helps to maximize cancer control,
because the cavernous nerves, which are frequently invaded by the prostate
cancer, are removed, an event that decreases the risk of leaving some cancer
behind. In addition, with this technique, quality of life can be improved by diminishing
the rate of impotence. As a result, prostatectomy could become more popular
for men.
On the other hand, according to Dr. Alan Partin Distinguished Professor of Urologic
Oncology at the Johns Hopkins Medical Center, in men where both nerves have
to be taken out during surgery, radiation therapy probably would be a better type
of treatment. In any way he also thinks that this is a wonderful research.
Dr. Partin is a member of the ACS Editorial Board.
It's worth saying that this procedure is performed at the Baylor College of Medicine, Houston, the University of Tennessee, the Texas University, the M. D. Anderson Cancer Center and few other centers in the United States.
20/04/2001 Dott. Domenico Alfieri