Penile Reinervation

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

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

In order to improve the quality of life of these patients regarding erectile dysfunction, teachers at the Botucatu Medical School of Unesp, in 2010, developed a surgical technique with nerve grafting to determine penile reinnervation.

The technique is based on end-to-side neurorrhaphy without lesion on the donor nerve, introduced in 1992 by Fausto Viterbo, Adjunct Professor of the Plastic Surgery Discipline and specialist in peripheral nerve microsurgery, in his PhD thesis, which was supervised by José Carlos Souza Trindade, Professor Emeritus of the Faculty of Medicine and retired Professor of Urology.

The proposed surgical technique, whose experimental protocol was approved by the National Research Ethics Commission (CONEP), consists of connecting the femoral nerves (in the inguinal region) and the dorsal nerves of the penis, as well as with the intracavernous structures, aiming at neurotization the same. In this way, the nervous impulses responsible for the erection are restored, which were interrupted with the damage to the cavernous nerves next to the prostatic capsule.

For this purpose, four bridge grafts are performed, using the sural nerve as a connecting element for neurorraphies, two on each side. The first graft is made between the lateral face of the femoral nerve, where the distal end of one of the four segments of the surreal grafts is sutured, and the lateral face of the dorsal nerve of the penis on the corresponding side, in which the proximal end of the graft is sutured. sural. The second graft is made between the lateral face of the femoral nerve, 1.5 cm distant from the previous one, in which the distal end of the second segment of the sural graft is also sutured, while its proximal end is buried, through a small opening in the albuginous tunic, inside the corpora cavernosa, near the base of the penis. The same procedure is performed on the contralateral side.

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

The results start with penile engorgement if they continue with flaccid erections, semi-rigid erections and then rigid until reaching intercourse with penetration.

In addition to Professors Fausto Viterbo and José Carlos Souza Trindade, previously mentioned, Professor José Carlos Souza Trindade Filho, Assistant Professor of the Department of Urology, also participates in the surgical team.