Surgical and Functional Outcomes of Penile Neurotization to Treat Post-Prostatectomy Erectile Dysfunction: Preliminary Results of a Novel Direct Somatic-to-Autonomic Procedure

Objectives: This study investigate the preliminary surgical and functional outcomes of a new direct somatic-to-autonomic penile neurotization procedure transposing the gracilis branch of the obturator nerve to the corpora cavernosa bilaterally in patients affected by erectile dysfunction (ED) after radical prostatectomy (RP). Materials and Methods: A prospective trial was conducted to evaluate erectile function through validated questionnaires after the surgical procedure in patients after RP non-nerve sparing (NNS) (Group 1) or nerve sparing (NS) (Group 2). Results: From October 2020 to January 2025, a total of 15 patients were enrolled in the study. Median age was 58 years (IQR: 54–61). 10 patients (66.7%) belong to the NS group while 5 (33.3%) underwent a NNS RP. The median time from RP to nerve transfer was 18 months (IQR: 13–26). No significant intraoperative or postoperative complications (greater than grade 1 according to Clavien-Dindo) were observed. As for functional results, a significant increase in median values of 3 validated questionnaires was noted at 24 months compared to the baseline evaluation. 41,7% of patients regained the ability to have satisfying sexual intercourse using PDE5i. The current sample size did not allow for a comparative analysis between the two groups. Conclusion: The preliminary outcomes of this pilot study indicate that the proposed technique appears feasible and safe, with early signals of potential benefit on erectile function. However, these findings are exploratory in nature and larger, well-designed are required to confirm the true clinical efficacy of this approach.