Recovery of erectile function after salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy

Objectives. To analyze the feasibility of neurovascular bundle (NVB) preservation and peripheral nerve grafting during salvage radical prostatectomy (RP) for radiorecurrent prostate cancer and analyze their effect on the recovery of potency. Methods. Of 100 patients who underwent salvage RP with curative intent from 1984 to 2003, 1 patients had bilateral NVBs preserved, 22 had a unilateral NVB preserved with (n = 11) and without (n = 11) a unilateral nerve graft, and 9 had bilateral NVBs resected with bilateral nerve grafts. Preoperative erections were graded as normal (grade 1) in 12 patients and full but recently diminished (grade 2) in 16. Recovery of potency after salvage RP was defined as erections satisfactory for intercourse, with or without the use of sildenafil. Results. Overall, 6 patients recovered potency after salvage RP, and the 5-year actuarial recovery rate was 16% (95% confidence interval 4% to 28%). The 6 patients who recovered erections all had preoperative grade I to 2 erections, and 5 had bilateral NVBs preserved. Only I of I I patients who had a unilateral nerve graft recovered potency. No patient with bilateral nerve grafts recovered potency. The 5-year actuarial recovery rate among patients with preoperative grade I to 2 erections was 45% (95% confidence interval 16% to 75%). Conclusions. Compared with standard RP, the overall potency results after salvage RP are poor. However, select patients with good preoperative erectile function who have bilateral NVB preservation may recover erections sufficient for intercourse aided by sildenafil. Peripheral nerve grafts did not appear to influence the recovery of erections in this patient population.