15642 Background: Over the past 20 years, radical prostatectomy has been a mainstay in the treatment of localized prostate cancer. With the adoption of nerve-sparing procedures, select patients may avoid the consequence of erectile dysfunction.Certain patients who are not candidates for nerve-sparing procedures may be eligible for nerve interposition grafts. While bilateral cavernosal nerve grafting after radical prostatectomy has shown efficacy, the effect of unilateral nerve grafting remains unclear. To further ascertain this outcome, we evaluated a large group of patients who underwent a unilateral cavernosal nerve replacement. Methods: Forty patients underwent unilateral nerve sparing surgery with concomitant contralateral cavernosal nerve replacement by a single surgeon from 2002 to 2006. Patient were selected based upon pre-op nomogram risk assessment, endorectal MRI evidence of extra capsular disease or intraop histology demonstrating margin positivity. Age, demographic data, Gleason score, clinical and pathologic stage and pre and post op IIEF data was collected and prospectively analyzed. An additional phone interview was conducted to assess outcomes and morbidity. Results: Full demographic and interview data was available for 28 of 40 patients (70%). Median follow-up was 19 months. The median age at RRP was 53 with a median pre-operative PSA of 6.5. Median pre- and post-op IIEF scores were 25 and 15 respectively. Median change in IIEF scores was 7.5. 22 of 28 patients (79%) men report being able to penetrate after surgery. 17 of those 22 (77%) continue to require PDE-5 inhibitors to facilitate penetration. 3 of the 6 patients (50%) who were unable to have intercourse following nerve replacement received adjuvant hormonal or radiation therapy. 27 patients (96%) reported numbness at the graft harvest site with three (10.7%) describing this as bothersome. One patient experienced a graft site infection and two of 28 (7.1%) patients reported pain at the harvest site. Conclusion: Unilateral sural nerve grafting is a feasible and well-tolerated approach for patients who must undergo wide resection of a neurovascular bundle. While men do show a sizable decrease in their IIEF score, 79% were able to achieve penetration following surgery. The majority of men require PDE-5 inhibitors to facilitate intercourse. No significant financial relationships to disclose.
Phase II prospective randomized trial of weight loss prior to radical prostatectomy