Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

ii. Nerve Grafting

Nerves are like electrical wiring. Their function is to carry and deliver a spark, jolting the muscle cells into moving. If the nerve were to die, the muscle can’t work because it’s missing the jolt of electricity to get it started. In theory, just as electricians can replace faulty wiring, surgeons should be able to replace faulty nerves. In practice, of course, it’s never that simple.

As we discussed earlier, the nerves that control erectile function run alongside the prostate. If the surgeon feels, for whatever reason, that the nerves cannot be spared during surgery, erectile function is lost. However, a number of years ago, surgeons started looking at the possibility of removing nerves from other locations in the body (most often from the side of the foot) and surgically attaching, or grafting, them to the ends of the cut nerves. About 30% of men undergoing this procedure report natural erections after about six months, and up to 50% achieve erections with the assistance of oral medications.

Note that because of the technical skill required to perform the procedure, nerve grafting is not widely practiced. In addition, men undergoing this procedure will be in surgery for a longer period of time and will have a second surgical incision at the point from where the nerve was taken, potentially increasing the chances for postsurgical complications. Therefore, a nerve-sparing prostatectomy should be the first choice; nerve grafting should be seen only as a potential option if the surgeon feels it is appropriate.