Nerve Graft in Association with Radical Prostatectomy
© Blue Cross and Blue Shield of Montana
Current Effective Date:
October 25, 2013
Original Effective Date:
October 25, 2013
July 25, 2013
Nerve grafting to replace cavernous nerves resected at the time of radical prostatectomy is proposed to reduce the risk of erectile dysfunction after this surgery. The sural nerve is most commonly used in grafting.
Erectile dysfunction is a common problem after radical prostatectomy. In particular, spontaneous erections are usually absent in patients whose extent of prostate cancer requires bilateral resection of the neurovascular bundles as part of the radical prostatectomy procedure. A variety of noninvasive treatments are available, including vacuum constriction devices and intracavernosal injection therapy. However, spontaneous erectile activity is preferred by patients. Studies have reported results from bilateral nerve grafts; there are also reports of unilateral grafts when only one neurovascular bundle has been resected.
There has been interest in sural nerve grafting to replace cavernous nerves resected at the time of prostatectomy. The sural nerve is considered expendable and has been used extensively in other nerve grafting procedures, such as brachial plexus and peripheral nerve injuries. As applied to prostatectomy, a portion of the sural nerve is harvested from one leg and then anastomosed to the divided ends of the cavernous nerve. Reports are also being published using other nerves, such as the genitofemoral nerve.
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185, 233.4, 607.84, 997.99, V45.77
C61, D07.5, N52.01, N52.02, N52.03, N52.1, N52.2,.N52.31, N52.32, N52.33, N52.34, N52.39, N52.8, N52.9, Z90.79, 0VT00ZZ
- Davis JW, Chang DW, Chevray P et al. Randomized phase II trial evaluation of erectile function after attempted unilateral cavernous nerve-sparing retropubic radical prostatectomy with versus without unilateral sural nerve grafting for clinically localized prostate cancer. Eur Urol 2009; 55(5):1135-43.
- Kim ED, Nath R, Slawin KM et al. Bilateral nerve grafting during radical retropubic prostatectomy: extended follow-up. Urology 2001; 58(6):983-7.
- Namiki S, Saito S, Nakagawa H et al. Impact of unilateral sural nerve graft on recovery of potency and continence following radical prostatectomy: 3-year longitudinal study. J Urol 2007; 178(1):212-6; discussion 16.
- Secin FP, Koppie TM, Scardino PT et al. Bilateral cavernous nerve interposition grafting during radical retropubic prostatectomy: Memorial Sloan-Kettering Cancer Center experience. J Urol 2007; 177(2):664-8.
- Sim HG, Kliot M, Lange PH et al. Two-year outcome of unilateral sural nerve interposition graft after radical prostatectomy. Urology 2006; 68(6):1290-4.
- Rabbani F, Ramasamy R, Patel MI et al. Predictors of recovery of erectile function after unilateral cavernous nerve graft reconstruction at radical retropubic prostatectomy. J Sex Med 2010; 7(1 Pt 1):166-81.
- Study of nerve reconstruction using AVANCE in subjects who undergo robotic assisted prostatectomy for treatment of prostate cancer (NCT00953277). Available online at: www.ClinicalTrials.gov . Last accessed November, 2012.
- National Comprehensive Cancer Network. Prostate Cancer. Clinical practice guidelines in oncology, v3.2012. Available online at: <nccn.org>Last accessed August 2013.
- Nerve Graft in Association with Radical Prostatectomy. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2013 July) Surgery 7.01.81.
||New 2013 BCBSMT medical policy. Unilateral or bilateral nerve graft in patients who have undergone resection of one or both neurovascular bundles as part of a radical prostatectomy is considered experimental, investigational and unproven. |