Study shows feasibility of genitofemoral nerve grafts during RP

Genitofemoral (GF) nerve grafting during radical retropubic prostatectomy can be performed safely with a low risk of postoperative morbidity and shows promising efficacy for returning erectile function after surgery involving wide nerve resection, according to the results of a retrospective study undertaken by urologists from Vanderbilt University, Nashville, TN.

The investigation considered 27 men who underwent RP between 2001 and 2003, of whom 22 (81%) received a single nerve graft with nerve-sparing contralaterally and five (19%) of whom had a bilateral graft. All of the surgeries were performed by Joseph A. Smith, Jr., MD, professor and chairman, department of urology at Vanderbilt.

Minimal morbidity was noted during a mean follow-up of 14 months. Results from a non-validated questionnaire used to assess sensory deficits showed that only two patients (6.5%) had any postoperative side effects. Both men reported a decrease in sensation in the ipsilateral anterior thigh and rated its severity as almost none or not bothersome.

Adequate preoperative data on erectile function were not consistently available in this retrospective study, but an exploratory analysis was performed to determine potency outcomes. The results showed 56% of the 27 men could achieve an erection firm enough for penetration either spontaneously or with sildenafil citrate (Viagra). In subgroup analyses, that outcome was achieved by 69% of men who had normal erectile function preoperatively, 52% of those who underwent a single nerve graft, and 20% of those in the bilateral nerve graft group, reported Bradford A. Nelson, MD, PharmD, a Vanderbilt resident who reported the data yesterday.

"While there have been concerns that GF nerve grafting may be associated with significant patient morbidity, the results of this study support its feasibility and safety," Dr. Nelson said. "Furthermore, although the follow-up is still early and no definitive conclusions can be drawn regarding erectile function given our study design, the rates of return noted, especially among men who had a bilateral graft, are very encouraging."