DESCRIPTION
Erectile dysfunction is a common problem after radical prostatectomy. In particular, spontaneous erections are absent in individuals whose extent of prostate cancer requires bilateral resection of the neurovascular bundles as part of the radical prostatectomy procedure. A variety of noninvasive treatments are available, including vacuum constriction devices and intracavernosal injection therapy. However, spontaneous erectile activity is clearly preferred by individuals.
Recently, there has been interest in sural nerve grafting to replace cavernous nerves resected at the time of prostatectomy. The sural nerve is considered expendable and has been used extensively in other nerve grafting procedures, such as brachial plexus and peripheral nerve injuries. As applied to prostatectomy, a portion of the sural nerve is harvested from one leg and then anastomosed to the divided ends of the cavernous nerve. To date, limited data has been published regarding the long-term outcomes of sural nerve grafting.
POLICY
Sural nerve graft in association with radical prostatectomy is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
No evidence is found in the published literature that validates the application of sural nerve graft or the long term outcomes in association with radical prostatectomy.
SOURCES
Abeloff, M. D., Armitage, J. O., Niederhuber, J. E., Kastan, M. G., & McKenna, W. G. (2008). Abeloff’s Clinical Oncology (4th ed.). Philadelphia: Churchill Livingstone Elsevier.
BlueCross Blue Shield Association. Medical Policy Reference Manual. (12:2010). Nerve graft in association with radical prostatectomy (7.01.81). Retrieved July 11, 2011 from BlueWeb. (8 articles and/or guidelines reviewed)
Wein, A. J., Kavoussi, L. R., Novick, A. C., Partin, A.. W., & Peters, C. A. (Eds.). (2007). Campbell-Walsh Urology (9th ed.). Philadelphia: Saunders Elsevier.
ORIGINAL EFFECTIVE DATE: 3/1/2003
MOST RECENT REVIEW DATE: 10/13/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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