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To the Editor.—Although agreeing with the authors of the article "Preservation of Erectile Function After Aortoiliac Reconstruction" in the August Archives (113:958-962, 1978), I question some of their anatomical conclusions. They emphasize the importance of nerve plexi around the inferior mesenteric artery in preserving erectile function.
Retroperitoneal lymph node dissection for testicular tumor usually entails complete mobilization of the aorta and vena cava from the renal pedicles down to the bifurcation, clearing of one of the common iliacs, and ipsilateral sympathectomy. The inferior mesenteric artery is routinely divided. These patients rarely lose erectile ability unless the dissection is carried out down both common iliacs. They almost regularly lose emission, but do continue with both orgasm and spasmodic contraction of the urethral musculature at intercourse.
This would emphasize that the pelvic nerve plexi and the hypogastric plexus are important in erectile function, but that the periaortic nerves and nerves around
BARNHOUSE DH. Preservation of Erectile Function. Arch Surg. 1979;114(2):226. doi:10.1001/archsurg.1979.01370260116023