Plastic Surgery Research Council
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Presenter: Paul S Cederna
Co-Authors: Waljee JF; Curtin CM; Wei JT; Montie JE; Kung TA
University of Michigan

Background: Open radical prostatectomy for treatment of prostate cancer is associated with urinary incontinence and erectile dysfunction. Immediate reconstruction of the prostatic plexus nerves by interpositional sural nerve grafting has been performed to reduce the morbidity of this procedure. Although the feasibility of this reconstruction has been determined, long-term outcomes have yet to be established.

Methods: A retrospective study was performed on 38 consecutive patients who underwent immediate unilateral or bilateral nerve reconstruction after open prostatectomy. Additionally, 53 control patients who underwent either unilateral, bilateral, or non-nerve sparing open prostatectomy without nerve grafting were reviewed. Outcomes of interest which were evaluated in this study included rates of urinary continence, erections sufficient for sexual intercourse, and ability to have spontaneous erections. Statistical analysis was performed by stratifying patients by D'Amico score and laterality of nerve involvement.

Results: The mean follow up for nerve grafting patients was 59 months. Unilateral nerve grafting resulted in no significant benefit compared to unilateral nerve sparing prostatectomy (Table 1). Bilateral nerve sparing patients demonstrated superior functional outcomes compared to bilateral nerve grafting patients and bilateral non-nerve sparing patients (Table 2). With increasing D'Amico score, there was a trend towards worsening urinary continence and erectile function regardless of nerve grafting status.

Conclusions: Interpositional nerve grafting reduced the morbidity of radical prostatectomy in patients with bilateral nerve resections and these effects were maintained after long-term follow up. There was no functional benefit of immediate nerve grafting for a unilateral nerve defect after unilateral nerve sparing prostatectomy. Therefore, the potential of bilateral nerve reconstruction of the prostatic plexus warrants continued investigation.

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