I remain skeptical about the value of nerve grafts in restoring sexual function in men who undergo wide excision of the neurovascular bundle and am concerned that it may encourage urologists to pursue wide excision where it is neither necessary nor useful. Patients who have invasion of the neurovascular bundles on both sides to the point where it is necessary to excise both neurovascular bundles are not curable with surgery. Today, most men with localized prostate cancer who undergo surgery can have preservation of both neurovascular bundles. Patients who have extensive disease outside the prostate are less likely to recover sexual function regardless of the status of their nerves and are unlikely to benefit from placement of a nerve graft. A randomized properly performed study of nerve grafts should be carried out before nerve grafts are widely accepted in the management of localized prostate cancer. The most valuable thing one can do to ensure the recovery of sexual function in a patient where it was necessary to widely excise one neurovascular bundle is not a nerve graft. Rather, it is precise preservation of the contralateral neurovascular bundle.
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