Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
J Sex Med. 2010 Jan;7(1 Pt 1):166-81. doi: 10.1111/j.1743-6109.2009.01436.x. Epub 2009 Aug 4.
Although studies have reported a benefit to bilateral cavernous nerve graft (NG) interposition, the role of unilateral NG interposition in recovery of erectile function (EF) after radical prostatectomy (RP) with unilateral neurovascular bundle (NVB) resection is more controversial.
To determine the probability and predictors of EF recovery after unilateral cavernous NG at RP with unilateral NVB resection.
We retrospectively reviewed the records of preoperatively potent men who underwent RP with unilateral NVB resection and ipsilateral NG without prior radiation or hormonal therapy from 1999 to 2007. Postoperative EF was defined in two ways: (i) physician interview-based assessment (level 3: erections sometimes sufficient for intercourse; level 2: erections routinely sufficient for intercourse; level 1: normal erections; all with or without oral phosphodiesterase-5 inhibitor use); and (ii) according to the sum Q3 + Q4 on the International Index of Erectile Function (IIEF) questionnaire.
EF recovery based on physician interview-based scale and IIEF questionnaire.
In all, 131 men underwent unilateral NG. Median follow-up was 37.3 months. The 5-year actuarial probability of EF recovery was 46, 30, and 12% for levels 3, 2, and 1, respectively, and 40, 34, and 22% for IIEF Q3 + Q4 sum > or =6, > or =8, and = 10, respectively. On multivariate analysis, patient age, specimen weight, and plastic surgeon were predictive of EF recovery based on physician-interview whereas patient age, ethnicity, and plastic surgeon were predictive of EF recovery based on the IIEF questionnaire.
The impact of plastic surgeon on EF recovery with unilateral NG would suggest that technical factors play a role in EF recovery after unilateral NG. Meticulous surgical technique with proper identification of proximal and distal recipient nerve endings may improve the chance of EF recovery. The variation in recovery rate among plastic surgeons would imply that there is a benefit to unilateral NG in EF recovery.
尽管有研究报道双侧海绵体神经移植（NG）置位对勃起功能（EF）恢复有益，但单侧 NG 置位在单侧神经血管束（NVB）切除后行根治性前列腺切除术（RP）后 EF 恢复中的作用更具争议性。
确定单侧 NVB 切除后行单侧海绵体 NG 时 EF 恢复的概率和预测因素。
我们回顾性分析了 1999 年至 2007 年间行单侧 NVB 切除和同侧 NG 而无先前放疗或激素治疗的术前勃起功能正常的男性患者的记录。术后 EF 采用两种方法定义：（i）基于医生访谈的评估（3 级：勃起有时足以进行性交；2 级：勃起通常足以进行性交；1 级：正常勃起；均有或无口服磷酸二酯酶-5 抑制剂使用）；和（ii）根据国际勃起功能指数（IIEF）问卷的 Q3+Q4 总和。
基于医生访谈量表和 IIEF 问卷的 EF 恢复。
共有 131 例男性患者行单侧 NG。中位随访时间为 37.3 个月。5 年累积 EF 恢复概率分别为 3 级 46%、2 级 30%、1 级 12%，以及 IIEF Q3+Q4 总和>或=6 级 40%、>或=8 级 34%、=10 级 22%。多变量分析显示，患者年龄、标本重量和整形外科医生是基于医生访谈的 EF 恢复的预测因素，而患者年龄、种族和整形外科医生是基于 IIEF 问卷的 EF 恢复的预测因素。
单侧 NG 中整形外科医生对 EF 恢复的影响表明，技术因素在单侧 NG 后 EF 恢复中起作用。精细的手术技术并正确识别近端和远端受体神经末梢可能会提高 EF 恢复的机会。整形外科医生之间恢复率的差异意味着单侧 NG 对 EF 恢复有益。
