Nerve graft for erectile dysfunction after radical prostatectomy: animal study and clinical data-a narrative review

Introduced in the late 1990s, nerve grafting, particularly with sural and genitofemoral nerves, aims to enhance erectile function recovery when neurovascular bundles cannot be preserved following radical prostatectomy. Over the past three decades, researchers have conducted numerous animal and clinical studies to explore the application and clinical effectiveness of this method, with the hope of benefiting patients suffering from erectile dysfunction after radical prostatectomy. Animal studies have demonstrated the potential of various grafting materials, including autologous nerve and vein grafts, and bioengineered grafts, in promoting nerve regeneration and erectile function recovery. Clinical studies, especially those focusing on sural and genitofemoral nerve grafts, have shown mixed results with varied success rates due to methodological weaknesses and small sample sizes. This review thoroughly incorporates current data, explores emerging nerve grafting methods, demonstrates the complexity of nerve grafting outcomes, and emphasizes the necessity for continuous research, including multi-institutional randomized controlled trials, to establish standardized protocols and optimize patient selection for nerve grafting in the management of erectile dysfunction after radical prostatectomy.