Prostate news article, August 2004
| NERVE GRAFTING CAN IMPROVE URINARY FUNCTION AFTER RADICAL PROSTATECTOMY Mr Khurshid Ghani MRCS (Ed), Urology Research Fellow St George’s Hospital. London |
Patients undergoing radical prostatectomy may rightly fear the complications of erectile dysfunction and urinary incontinence. Since the introduction of the ‘nerve-sparing’ radical prostatectomy in the 1980s by Dr Patrick Walsh from Johns Hopkins in the United States, these complications are less common. However, in some patients, the location and pathology of the prostate cancer will necessitate a more radical operation where the nerves on either side of the prostate that help to preserve erectile function and contribute to urinary control, are excised with the gland. These patients undergoing nerve excision are obviously at a higher risk of morbidity. Previous studies have shown that performing a nerve graft at the time of surgery using the sural nerve from the calf can reduce post-operative erectile dysfunction. The effect of nerve grafting on urinary control has not been well documented.
In the June edition Urology, Singh et al (Urology 63:1122-1127, 2004) publish results comparing urinary function in patients undergoing unilateral nerve excision and sural nerve grafting (SNG) with patients undergoing unilateral nerve excision without SNG. They studied over 100 consecutive patients over 4 years. All were offered SNG and voluntarily chose which treatment group to belong to. Validated questionnaires were used to assess how quickly these two groups achieved urinary control and what level of continence was finally achieved. They found that 12 months after radical prostatectomy, patients undergoing SNG had significantly better urinary control (reporting either no need for a pad or a few drops of urine on the pad) than those patients who did not have a SNG (94.7% vs 58.3% respectively). Patients who had SNG also had a faster rate of recovery. Other factors that can affect outcome, such as the PSA and Gleason grade, were found to have no influence on urinary function at 12 months.
Although this study is not a randomised trial, the vast improvement in those patients undergoing SNG provides encouragement to patients considering this option. Certain centres in the United States (Cleveland Clinic) are now employing this technique laparoscopically. We need to await results from multi-centre randomised trials to see if this can be a standard technique offered to patients on both sides of the Atlantic.