Penile reinnervation in the treatment of iatrogenic erectile dysfunction in patients after radical prostatectomy.

Introduction. Radical prostatectomy (RP) remains the main, iatrogenic cause of erectile dysfunction (ED) and, despite the development and implementation of modern methods such as laparoscopy and robotic surgery, the relevance of ED after RP remains at a high level. Objective. To evaluate the effectiveness of a new penile reinnervation method using a n. suralis graft with distal fraying and end-to-side neuroraphy between the motor fasciculus of the femoral nerve and the cavernous body in patients undergoing RP. Materials and methods. 16 patients with an average age of 60,4 years who underwent RP were included in the study. All patients had satisfactory sexual activity before surgery. After RP all patients underwent penile reinnervation, including end-to-side neuroraphy between the femoral nerve and the sural nerve, as well as penile graft implantation into the cavernous bodies. Prior to the procedure, patients underwent preliminary assessments of sexual function. Results. After penile reinnervation, a significant improvement in erectile function was observed in all patients. The assessment of sexual function using the IIEF-5 questionnaire showed an improvement in the average value from 5 to 16 points. In addition, the occurrence of spontaneous tumescence in all patients at night was noted. Conclusions. Reinnervation of the penis using n. suralis graft and end-to-side neuroraphy can be an effective method of restoring erectile function in patients after RP. Further studies with larger patient samples are needed to confirm the results and optimize this procedure.