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Technique shows potential in restoring erectile function after cancer-related radical prostatectomy
A minimally invasive surgical technique restored erectile function among most of a small cohort of men who underwent radical prostatectomy for prostate cancer, according to study results.
“We looked at sexual quality of life before and after [the procedure],” Christopher Coombs, MD, MBBS, FRACS, clinical professor at the University of Melbourne, and plastic surgeon at Southern Plastic Surgery in Australia, said in a press release. “Regaining erectile function had a significant impact on quality of life and the way the men felt about themselves.”
The analysis included 17 men (median age, 64 years; interquartile range, 60-66) with severe or moderate post-prostatectomy erectile dysfunction. All men had undetectable PSA levels and underwent the minimally invasive technique, end-to-side nerve grafting, between March 2015 and October 2017.
Results showed the procedure was safe and resulted in an overall 71% success rate.
Coombs told HemOnc Today about the study, why he and his colleagues thought this technique could work, and what is next for research.
Question: What prompted this research?
Answer: Every year, nearly 1.3 million men worldwide undergo radical prostatectomy for the treatment of prostate cancer. Of these, about 70% will be left with erectile dysfunction. There is a huge need to help these men. We started performing end-to-side nerve grafting for men following radical prostatectomy for prostate cancer in 2015, following reports from Brazil. Our procedure is simplified compared with the Brazilian procedure. This was a new utilization of an established technique, so we needed to ensure that the technique achieved appropriate outcomes.
Q: What was the rationale for why this technique may work?
A: There are several uses for end-to-side nerve grafting in facial palsy and other peripheral nerve surgery that are quite established. It is used when you do not have a nerve that is expendable for an end-to-end nerve graft. Grafting to the side of the donor nerve, with appropriate preparation of the donor nerve, results in sprouting from the donor nerve into the nerve graft without reduction of donor nerve function. Utilizing it for penile reinnervation from the femoral nerve results in a new nerve circuit that provides the same chemical, which is one of the initiators of erection, from the femoral nerve that was provided from the cavernous nerves divided during the prostatectomy.
Q: How did you conduct the study?
A: It was a retrospective review of 17 patients who had undergone end-to-side nerve grafting for erectile dysfunction following radical prostatectomy. We followed patients for at least 12 months — the time frame that nerve regeneration would be expected to reach the penis from the femoral nerves. We looked at recovery of erectile function and quality-of-life outcomes.
Q: What did you find?
A: We found that the procedure restored erectile function in 71% of men who underwent the procedure. Approximately half of these men had spontaneous function, whereas the others required oral drugs. One patient who recovered function had erectile dysfunction for 12 years. The other important finding was how recovery of erectile function correlated with a clinically significant improvement in men’s quality of life, which was great to see.
Q: What is next?
A: Following these encouraging results, we are planning to further analyze our outcomes. We plan to have the results of a larger study in the next year or so to ensure that our results hold up and see if we can work out why it is not successful in the 29% of men who did not have recovery of erectile function.
Q: Is there anything else that you would like to mention?
A: We feel that this procedure could be an important step forward in helping men who have erectile dysfunction following treatment for prostate cancer. Many of these men suffer in silence, and now there is light at the end of the tunnel for many of them. – by Jennifer Southall
Reference:
Reece JC, et al. Eur Urol. 2019; doi:10.1016/j.eururo.2019.03.036.
For more information:
Christopher Coombs, MD, MBBS, FRACS, can be reached at Southern Plastic Surgery, 883 Hampton St., Brighton 3186, Australia; email: chris@southernplasticsurgery.com.au.
Disclosure: Coombs reports no relevant financial disclosures.