Iman Sadri, MD, Explains Novel Nerve Grafting for Post-Prostatectomy ED

Sadri began by discussing the scientific rationale behind exploring somatic-to-autonomic nerve grafting as a novel strategy for erectile dysfunction following radical prostatectomy. According to Sadri, prior attempts at nerve grafting within the prostatic fossa largely failed, likely because well-formed nerve grafts were placed into an area dominated by microscopic nerve plexuses, limiting meaningful reconnection. More recent international studies, however, showed encouraging results using extensive nerve grafting procedures that linked major somatic nerves to the corpora cavernosa, demonstrating that functional recovery might be possible, even if the approach was too invasive for widespread adoption. Building on these insights, Sadri and colleagues designed a phase 1 feasibility study to test a less invasive alternative. Their approach uses the ilioinguinal nerve, which is more easily harvested by urologists, and connects it to the dorsal penile nerve, a structure closer to the corpora cavernosa. While this somatic-autonomic connection challenges traditional nerve grafting dogma, the team hypothesizes that the benefit may come from amplifying afferent sensory signaling to the spinal cord, thereby strengthening erectile reflex pathways and potentially promoting downstream nerve regeneration in patients with residual pelvic nerve integrity after prostatectomy. Early interim results from the trial are promising. The trial enrolled 10 patients, all of whom had severe erectile dysfunction following radical prostatectomy despite medical therapy and adequate recovery time. At just over 3 months post-grafting, 5 of 10 patients were able to achieve penetrative intercourse, with average IIEF scores improving from 5 at baseline to 11.5. Although this still reflects mild-to-moderate dysfunction, Sadri notes that continued improvement may occur over time based on broader nerve regeneration literature. REFERENCE 1. Sadri I. Phase I Clinical Trial: Somatic-Autonomic Nerve Grafting Technique to Restore Erectile Function in Patients with Persistent Erectile Dysfunction Post Radical Prostatectomy. Presented at: Urology on the Beach 2026. January 16-18, 2026. Miami Beach, Florida.