Nerve Repair for Erectile Dysfunction After Radical Prostatectomy: A Systematic Review of Outcomes

Background: Erectile dysfunction (ED) is a prevalent complication after radical prostatectomy (RP), affecting up to 89% of patients within 2–5 years due to cavernous nerve injury. Nerve grafting has been proposed as a strategy to restore erectile function, but outcomes remain inconsistent, and randomized controlled trials have yielded mixed results. This review evaluated the effectiveness of nerve grafting techniques for ED management after RP. Methods: A systematic search of PubMed, MEDLINE, and Embase databases was conducted using terms related to ED, nerve grafting, and cavernous nerve repair. From 239 initial studies, 17 met the inclusion criteria, focusing on human subjects and reporting outcomes of unilateral or bilateral nerve grafting with autologous donor nerves, such as the sural and genitofemoral nerves. Results: Bilateral sural nerve grafting demonstrated the highest recovery rates, with up to 71% of patients regaining erectile function sufficient for intercourse. Adjunctive therapies like sildenafil were frequently used to enhance outcomes. However, randomized controlled trials showed no statistically significant improvements compared with controls, raising questions about the efficacy of nerve grafting. Variability in outcomes seemed to be influenced by donor nerve choice, surgical expertise, and patient characteristics, such as age and baseline function. Conclusions: Although bilateral sural nerve grafting offers promising results, its overall efficacy is uncertain due to inconsistent findings and limitations of existing studies. Larger, standardized trials are essential to clarify its role in ED management after RP and to optimize patient outcomes.