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Nerve grafting, most commonly using the sural nerve, at the time of radical prostatectomy has been proposed to reduce the risk of postoperative erectile dysfunction.
Erectile dysfunction is a common problem after radical prostatectomy. In particular, spontaneous erections are absent in patients 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 preferred by patients. Studies report results from bilateral nerve grafts; they also report of unilateral grafts when only one neurovascular bundle has been resected.
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. Reports are also being published using other nerves, such as the genitofemoral nerve.
A nerve graft in association with radical prostatectomy is a surgical procedure and as such is not subject to regulation by the U.S. Food and Drug Administration.
POLICYUnilateral or bilateral nerve graft is considered investigational in patients who have undergone resection of one or both neurovascular bundles as part of a radical prostatectomy.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY11/2003: Approved by Medical Policy Advisory Committee (MPAC)
1/21/2004: Code Reference section completed
1/22/2007: Policy reviewed, no changes
5/16/2007: Policy reviewed, description updated
5/9/2008: Policy reviewed, no changes
04/22/2010: Policy description updated. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section. Deleted outdated references from the Sources section.
02/23/2011: Policy reviewed; no changes.
01/18/2012: Policy reviewed; no changes.
04/02/2013: Policy reviewed; no changes.
03/07/2014: Policy reviewed; no changes.
01/30/2015: Policy reviewed; description updated. Policy statement unchanged.
SOURCE(S)Blue Cross Blue Shield Association policy # 7.01.81
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.