Nerve Grafting and Erectile Dysfunction
Corpus cavernosum neurotization for erectile dysfunction treatment
Erectile dysfunction is the inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance. Non-surgical treatments for PDE5i-refractory erectile dysfunction (Viagra or Cialis) are limited to negative pressure pumps and intra cavernous injections, which are often associated with high dropout rates. Penile prosthesis are associated with up to 17% of adverse complications.
The purpose of nerve transplants is to create new nerve pathways from a donor nerve to the denervated end organs. Souza Trindade in Brazil then Reece in Australia developed the technique that we refined. It’s a nerve grafting between the femoral nerve and directly the cavernous corpus. The goal is to create within 12 months after the nerve transplant, new nerve connections in the corpora cavernosa, which will help to restore erectile function.
The technique is done under general anesthesia by removing the sural nerve located on the lateral side of the leg that leaves a numbness on the external side of the leg (Fig. 1, 2, 3) then we expose the femoral nerves and the cavernous bodies that we connect in microsurgery with the nerve transplant (Fig. 4). Six centimeters of nerve graft is buried into each of the cavernous bodies from a mini opening at the base of the penis. To allow nerve transplants to heal, patients abstain from sexual activity for 3 months.
Significant improvement in erectile function occurs in 70% of men. In men whose erectile function has been restored, more than half will no longer need pharmacological assistance.