Harvard Perspectives on Prostate Disease

Can nerve grafts effectively restore erectile function?

A look at what the studies show

Until 1981, urologists believed that the nerves responsible for erections ran through the prostate. But that year, Dutch urologist Pieter Donker showed that the nerves ran down the sides of the gland, not through it. That discovery got urologic surgeons thinking: perhaps a cancerous prostate could be removed without harming the nerves, preserving a man's erectile function.

The following year, the first so-called nerve-sparing radical prostatectomy was performed. Today, most surgeons aim to spare the neurovascular bundles when performing prostate surgery. This helps men who were potent prior to surgery regain erectile function, and some studies show that it may also minimize urinary incontinence.

Unfortunately, the surgeon, whose main goal is to eliminate the cancer, can't always spare the nerves. For example, the cancer might have grown through the prostate capsule and into the nerves, making their removal a must. Or the cancer might be at the edges of the gland, increasing the risk that a few cancerous cells might be left behind; the surgeon might make a wider cut to ensure a cure but sacrifice erectile nerves in the process. In some cases, neither nerve bundle can be saved.

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