Abstract
Erectile dysfunction following radical prostatectomy remains a frequent problem despite the development of nerve-sparing techniques. This erectile dysfunction is believed to be neurogenic, enhanced by hypoxia-induced structural changes which result in additional veno-occlusive dysfunction. Recently, daily use of intracavernous vasoactive substances and oral use of PDE5-inhibitors have been clinically studied for treatment of postprostatectomy erectile dysfunction. Since these studies showed benefits of “penile rehabilitation therapy,” these effects have been studied in a preclinical setting. We reviewed experimental literature on erectile tissue preserving and neuroregenerative treatment strategies, and found that preservation of the erectile tissue by the use of intracavernous nitric oxide donors or vasoactive substances, oral PDE5-inhibitors, and hyperbaric oxygen therapy improved erectile function by antifibrotic effects and preservation of smooth muscle. Furthermore, neuroregenerative strategies using neuroimmunophilin ligands, neurotrophins, growth factors, and stem cell therapy show improved erectile function by preservation of NOS-containing nerve fibers.
Highlights
Cancer of the prostate is recognized as one of the principal medical problems in the male population [1]
A cross-regulation of intracellular cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) in cultured human corpus cavernosum smooth muscle cells was found by Kim et al They showed a rise in cGMP as a response to a rise in intracellular cAMP, which is accomplished by intracavernous injection of prostaglandin E1 (PGE1) [61, 62]
Nerve-sparing techniques are rapidly emerging, erectile dysfunction (ED) following radical prostatectomy remains a major problem for the prostate cancer patient and his urologist
Summary
Cancer of the prostate is recognized as one of the principal medical problems in the male population [1]. Radical prostatectomy (RP), either retropubic, perineal, laparoscopic, or robot-assisted laparoscopic, is the treatment of choice in young men with clinically localised prostate cancer. Since prostate cancer is detected at increasingly younger age and lower stage, patients undergoing radical prostatectomy generally have good baseline erectile function, and have high expectations concerning the preservation of erectile function following the procedure. Since Walsh and Donker published their insights in the etiology and prevention of impotence following retropubic RP in 1982, the nerve-sparing technique they described is widely employed to improve postoperative erectile function [2, 3]. In 1997, Montorsi and colleagues introduced the concept of early postoperative vasoactive therapy and penile rehabilitation, and they suggested that the early postoperative use of intracavernosal injection therapy to promote penile erection may result in improved erectile function outcomes [13]. This review article attempts to summarize the contemporary basic scientific knowledge on the pathophysiological mechanisms of post-RP ED and to review current basic science evidence for medicinal, nonchirurgical penile rehabilitation therapy and neuroregenerative therapies
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