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Erectile dysfunction is a common problem after prostatectomy. A variety of noninvasive treatments are available, including vacuum constriction devices and intracavernosal injection therapy. Nerve grafting at the time of prostatectomy, most commonly using the sural nerve, has been proposed to reduce the risk of postoperative erectile dysfunction. The sural nerve is considered expendable and has been extensively used in other nerve grafting procedures, such as brachial plexus and peripheral nerve injuries. As applied to prostatectomy, a portion of the sural nerve is harvested from one leg and then anastomosed to the divided ends of the cavernous nerve. Reports also indicate use of other nerves (e.g., genitofemoral nerve) for grafting.
A nerve graft with radical prostatectomy is a surgical procedure and, as such, is not subject to regulation by the U.S. Food and Drug Administration (FDA). Several nerve cuff products have been cleared for marketing by FDA through the 510(k) process. An example of a human tissue nerve graft product, the Avance® nerve graft (AxoGen), is regulated by FDA under the 21 CFR Part 1271 regulations for Human Cellular and Tissue-based Products (HCT/P).
Unilateral or bilateral nerve graft is considered EXPERIMENTAL/INVESTIGATIVE in patients who have had resection of one or both neurovascular bundles as part of a prostatectomy due to the lack of clinical evidence demonstrating an impact on improved health outcomes.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
CDT codes copyright American Dental Association® 2023. All rights reserved.
