Introduction: Interposition nerve grafting during radical retropubic prostatectomy was first described in the 1990s as a technique to improve post-operative erectile function in patients for whom a nerve sparing procedure was not an option. The technique involves the harvest of a sural nerve graft, which is then used to the replace cavernous nerves resected during the prostatectomy. We report our experience with this procedure.

Results: From 2003 to present, we have had fifteen patients requiring sural nerve grafts during prostatectomy. Six patients required bilateral grafts and nine required unilateral grafts. Graft lengths ranged from 3cm to10cm with medians of 5.6cm (unilateral) and 9.3cm (bilateral). There were no donor site complications. Five patients were able to achieve spontaneous erections after nerve grafting with a mean follow up of 416 days (range 43-1097) from surgery. Higher potency rates are expected after a longer interval post prostatectomy.

Conclusions: Sural nerve grafts are technically feasible with little morbidity and confer an improved chance of recovering erectile function for patients in whom nerve sacrifice is oncologically required during retropubic prostatectomy.