Peroneal Nerve Graft for Erectile Dysfunction

Last Modified: March 16, 2008

Dear OncoLink "Ask The Experts,"

A fellow told me that when he had surgery at Sloan Kettering in NYC, they were prepared to graft nerve tissue from his heel if there was damage to nerves that would affect sexual function. That did not come to pass for him, but he said it did for another person and the result was good. This was a first and only I heard of this. Have you heard of it?

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

They are talking about a peroneal nerve graft. This nerve carries sensation to the heel region and is not a really important nerve, so it is expendable in a sense. When urologists do a radical prostatectomy and they need to remove the neurovascular bundle, they will use a length of your peroneal nerve to replace the nerve that was removed in the “neuro” part of the neurovascular bundle. It is actually kind of cool. They have to graft the nerve in very carefully, because each nerve is only about 1-2mm across. They then use a nerve stimulator to stimulate the nerve proximal to the graft and see if the man gets an erection. That tells them that the graft is working. They actually do this 8 to 10 times to be sure it is functioning properly.

Dr. Peter Scardino, Chief of Urology at Memorial Sloan Kettering Cancer Center, is the expert at this procedure, and he reports that when the graft works in the operating room, there is about a 50% chance that it will work permanently. In a radical prostatectomy, they use a 2 cm length of the nerve, and the blood supply called the “vasa nervorum” is supplied from both ends. If you tried to perform this in abdominal cancers which can have erectile dysfunction as a complication, I would suspect that you would need a 10 to 15cm length of the nerve, and the likelihood of a compromised vasa nervorum somewhere along the length would be pretty high. All you need is a small area where the blood supply is lost and the tissue dies somewhere along the length of the nerve, and the whole nerve becomes useless. So, while peroneal grafting is successful in some prostate cancer cases, it may not be good for other abdominal surgeries.