Dual innervation method to preserve erectile function following prostatectomy

Prostate cancer is the second most prevalent cancer in men. Robot-assisted radical prostatectomy (RARP) has altered the landscape of prostate cancer treatment. Despite the excellent oncological outcomes associated with RARP, the rate of erectile dysfunction (ED) remains high. Primary repair of disrupted cavernous nerves with interpositional nerve grafts has been described; however, the outcomes have been inconsistent. We hypothesize that this is attributed to Schwann cell atrophy and axonal regeneration limitations caused by long nerve grafts. We proposed the use of nerve transfer to support axonal regrowth via an inter-positional graft with additional donor axons. A cadaveric study was performed to evaluate the anatomical feasibility of a vastus lateralis nerve (VLN) transfer to the distal recipient cavernous nerve stump. The VLN is long with multiple branching patterns that allow tension-free coaptation of the cavernous nerve. We postulate that a dual innervation method using VLN nerve transfer together with interpositional nerve graft repair of the transacted cavernous nerves may improve the outcomes of ED post-RARP.