Penile Reinnervation

Penile Reinnervation

The treatment of prostate cancer presented a significant improvement, with a concomitant reduction of its complications, after the improvement of the surgical technique of the radical prostatectomy proposed by Walsh in the eighties of the last century. The main innovation of this technique was the preoccupation with the preservation of the vascular-nervous bundles that transit next to the posterior face of the prostatic capsule, which will form the cavernous nerves, responsible for the triggering of the penile erection.

Although it has declined considerably, erectile dysfunction, despite all the surgeon’s care and expertise, continues to occur in a large number of patients.

To improve the quality of life of these patients regarding erectile dysfunction, in 2010, professors of Botucatu Scholl of Medicine / Unesp, developed a surgical technique with nerve grafting to determine penile reinnervation.

The proposed surgical technique, whose experimental protocol was approved by the National Ethics Commission for Research (CONEP), consists of connecting the femoral nerves (in the inguinal region) and the dorsal nerves of the penis, as well as intra cavernous corpus, with nerve sural grafts. In this way the nerve impulses responsible for erection are restored.

In order to do this, four bridging nerve grafts are performed, using the sural nerve as the connecting element, two of each side. The first graft is sutured to the lateral aspect of the femoral nerve where the distal end of one of the four segments of the sural grafts is sutured, and to the lateral side of the dorsal nerve of the penis. The second graft is sutured also to lateral aspect of the femoral nerve, and the other extremity is buried inside the cavernous bodies, near the base of the penis. The same procedure is performed on the contralateral side.

In all the neurorrhaphy performed in the femoral nerve, because it is a thick nerve, a small window of the epineurium is removed, to facilitate the budding of neo formed fibers. In the dorsal nerves of the penis, because they are very thin, this window is not performed.

The results begin with penile engorgement and continue with flaccid erections, semi-rigid erections and then rigid until reaching penetration stage.

The team are composed by Professors Fausto Viterbo, plastic surgeon, José Carlos Souza Trindade, and José Carlos Souza Trindade Filho, both urologists.