Long-term follow-up of treatment of erectile dysfunction after radical prostatectomy using nerve grafts and end-to-side somatic-autonomic neurorraphy: a new technique
| Autor: | André Petean Trindade, Fausto Viterbo, José Carlos Souza Trindade-Filho, José Carlos Souza Trindade, Wagner José Fávaro |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Urologic Surgical Procedures Male Urology medicine.medical_treatment 030232 urology & nephrology Sural nerve Autonomic Nervous System Neurosurgical Procedures 03 medical and health sciences Prostate cancer Postoperative Complications 0302 clinical medicine Erectile Dysfunction Sural Nerve Femoral nerve Humans Medicine Aged Prostatectomy business.industry Middle Aged medicine.disease Surgery Sexual intercourse Erectile dysfunction medicine.anatomical_structure 030220 oncology & carcinogenesis business Femoral Nerve Penis Follow-Up Studies Reinnervation |
| Zdroj: | BJU International. 119:948-954 |
| ISSN: | 1464-4096 |
| DOI: | 10.1111/bju.13772 |
| Popis: | Radical prostatectomy (RP) for prostate cancer treatment, although effective, can lead to severe erectile dysfunction. This study describes a new technique, which aims to reestablish the nerve stimulus in penile erection by two sural nerve graft bridges bilaterally, using the end to side neurorraphy. The first bridge is between femoral nerve and dorsal nerve of penis and the second, is between the femoral nerve and the interior of the corpus cavernosum. In this neurorraphy the endings of the newly formed fibres, generated by the femoral nerve, release acetylcholine inside the cavernous bodies, beginning the erection mechanism. Objective To study a novel penile reinnervation technique between the femoral nerve with the corpus cavernosum and dorsal penile nerves via sural nerve grafts by end-to-side neurorraphies. Patients and Methods Ten patients with a mean age of 60.3 ± 4.8 years (54 – 68) who had undergone RP at least two years previously were submitted to penile reinnervation. Four patients had undergone radiotherapy following RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire, Pharmacopenile Doppler Ultrassonography (PPDU) pre-operative and with 6, 12 and 18 months post-operative, and by a clinical evolution of erectile function (CEEF) questionnaire during 36 months. Results IIEF presented improvements for erectile dysfunction, satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between right and left sides or between the allocated time periods. The introduction of nerve grafts neither cause fibrosis of the corpus cavernosum, nor reduced penile vascular flow. Regarding CEEF, sexual intercourse began after 13.7 months on average, with frequency of sexual intercourse (SI) varying from once daily to once monthly. Acute complications were minimal. This study was limited by the number of cases. Conclusions Sixty percent of cases achieved full penetration, on average, thirteen months after reinnervation surgery. One may observe that patients previously submitted to radiotherapy presented slower recuperation of erectile function. One may conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer itself as a new treatment modality for erectile dysfunction following radical prostatectomy. This article is protected by copyright. All rights reserved. |
| Databáze: | OpenAIRE |
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