Every year, 8500 Australian men with prostate cancer undergo radical prostatectomies; at least 70% of these individuals also suffer from erectile dysfunction as a side effect of the procedure. This is because radical prostatectomies may injure penile nerves to the spongy tissue–aka the corpora cavernosa–which are in charge of causing erections. A large portion of men who undergo the procedure are unaware of this risk prior to undergoing the surgery or simply don’t speak up about what they’re going through, likely due to taboo surrounding the subject. Treatment generally comprises of prostheses or injections, which often come with unpleasant side effects of their own.
But there is hope yet. A team led by Microsurgeon and Professor Christopher Coombs in Melbourne, Australia have helped perfect a way to help men who have lost erectile function after receiving prostate cancer surgery. The technique, which was pioneered in Brazil, involves using a nerve translocated from the patient’s leg to help rebuild erectile function. The surgery saw an incredibly promising success rate of 71%, and two patients even had their first erections in over a decade. The technique even has the potential to revive men’s capacity to have “satisfactory sexual intercourse.” The team also published an accompanying study in European Urology; this paper was the first to cover this procedure.
The technique used is known as “end-to-side-nerve grafting” and first appeared in a medical journal back in 1903; it doesn’t appear to have been used again until 1992. That’s when Brazilian surgeon Fausto Viterbo began using it on a general scale. It wasn’t until 2017 that Viterbo reported using this grafting technique to restore erectile function in post-prostatectomy men. It was after this that Coombs et al simplified–and likely improved–upon the technique.
“End to end nerve grafting” involves the removal of the leg’s sural nerve, which is unnecessary for walking, and grafting it to the side of the thigh’s larger femoral nerve. Then, new nerve fibers grow along the grafted sural nerve and into the penis’s corpora cavernosa, which is responsible for achieving erections. Coombs and his team have updated this procedure by instead removing two sural nerves from the legs; one is attached to the femoral nerve in the thigh and the other to the corpus cavernosa. The sural nerve then functions as a sort of extension cord that brings regenerating nerve fibers from the femoral nerve directly to the corpus cavernosa. After about a year, these new nerve endings in the corpus cavernosa help initiate erections by releasing neurotransmitters.
Moving forward, Coombs and his team plan to continue testing their techniques in multi-center clinical settings to confirm efficacy and usefulness.