During radical prostatectomy, which neural structure is most at risk for injury leading to erectile dysfunction?

• A. Pudendal nerve
• B. Cavernous nerves
• C. Sciatic nerve
• D. Femoral nerve

Answer: (B)

Penile erection requires parasympathetic signaling to the corpora cavernosa to cause smooth muscle relaxation and increased blood flow. Those parasympathetic fibers travel with the cavernous nerves in the pelvic neurovascular bundles that run along the posterolateral aspect of the prostate. During radical prostatectomy, these nerves are at risk, and injury to them disrupts the nerve signals needed to achieve an erection, leading to erectile dysfunction. The pudendal nerve provides somatic sensation and motor control to pelvic floor structures and the penis but is not the primary driver of erection; damage can affect sensation or reflexes but doesn’t directly explain the loss of erectile capability. The sciatic and femoral nerves serve the lower limb, so injury to them would manifest as leg problems rather than erectile dysfunction.