February 2022
Approximately one-third of men develop erectile dysfunction after radical prostatectomy.
Why this matters
Approximately one-third of men develop erectile dysfunction after radical prostatectomy. This work contributes to evidence-based plastic and reconstructive surgery — helping clinicians interpret outcomes, refine technique, and counsel patients with clearer data.
Author
Plastic and reconstructive surgery resident at Emory University (UCLA BS, USC MD) with an h-index of 15 and peer-reviewed work spanning aesthetic surgery, reconstruction, medical devices, and AI in medicine.
Abstract
Approximately one-third of men develop erectile dysfunction after radical prostatectomy. Microsurgical grafts of various nerves have been shown to successfully correct neurogenic erectile dysfunction (nED). However, little is known about the anatomic variations of these nerves in the exploration of nerve transfer to avoid using a graft. This study seeks to identify structural, topographic, and distributional variations in humans of the ilioinguinal and genitofemoral nerves, as well as to identify the best candidates for end-to-end neurorrhaphy in patients with sensory or parasympathetic penile dysfunction, with a single coaptation reducing axonal dropout. Three adult male cadavers were obtained from the USC Keck School of Medicine fresh tissue cadaver lab. The diameter, length, and number of sensory branches of the left ilioinguinal, genitofemoral, and dorsal nerve of the penis were assessed in each cadaver. Distance from sensory branch points of the ilioinguinal and genitofemoral nerves to the base of the dorsal nerve of the penis and to the cavernous plexus of the prostate were also measured. The genitofemoral nerve (1.8 mm) was found to be larger in diameter than the ilioinguinal (0.9 mm) in all cadavers (p > 0.05). Mean distance to the dorsal nerve of the penis measured 8.0 cm, and 6.6 cm to the cavernous plexus. The dorsal nerve of the penis demonstrated an average of 3.3 sensory branches, with mean diameter of 1.6 mm. The average diameter of the dorsal nerve of the penis proper measured 3.7 mm across cadavers. The genitofemoral and ilioinguinal nerves have been identified as potential candidates for end-to-end neurorrhaphy to the dorsal nerve of the penis in the setting of neurogenic erectile dysfunction, with the aim at avoiding nerve grafting.