Penile Nerve Research Articles

Prospective Randomized Controlled Study Comparing Caudal Block versus Dorsal Penile Nerve Block as Postoperative Analgesia in Children Presented for Penile Surgery

AbstractBackground: Caudal block is recommended for analgesia during and after surface operation on the penis, for example circumcision and hypospadias repair. The aim of this study was to compare caudal block versus dorsal penile block in children undergoing penile surgery, regarding duration and quality of post-operative analgesia.Aim of the Study: To compare caudal block versus dorsal penile block in children undergoing penile surgery, our primary outcome was the duration of postoperative analgesia while our secondary outcome was the quality of post-operative analgesia.Patients and Methods: 60 children, ASA I-II, 1-4 year's old undergoing penile surgery under general anesthesia were enrolled in the study. Children were randomly classified into two groups: (Group I) (penile group=30 patients) received a penile block using a mixture of lidocaine 3mg/kg (2%) and plain bupivacaine 1mg/kg (0.25%) on each side, Group II (caudal block group=30 patients) patients of this group received a caudal block using a mixture of lidocaine 3mg/kg (2%) and plain bupivacaine 1mg/kg (0.25%). Assessment of post-operative will be done by the Faces Pain Scale which is a self-report measure of intensity developed for children. It was adapted from the Faces Pain Scale to make it possible to score the sensation of on the widely accepted 0-to-10 metric, 0 equals no pain and 10 equals very much pain. This done immediately postoperative and every 2H until 6H post-operative.Results: Faces score was significantly lower in group II at 2H, 4H and 6H post-operative with increase on the duration of block in Group II, also there was significant decrease in heart rate in Group II at 30min, 45min, 75min, 90min, 105min, 120min and 135min respectively from the start of surgery so there was significant increase of bradycardia and need of atropine in group.Conclusions: Caudal block seemed to be more effective in reducing post-operative score and decreasing the need of rescue analgesia with prolongation of the duration of the block.

Effect of operative local anesthesia on postoperative pain outcomes of inflatable penile prosthesis: prospective comparison of two medications.

Few studies have examined the roles of dorsal penile nerve block (DPNB) and penile ring block (PRB) in surgery of inflatable penile prosthesis (IPP) placement. We sought to compare the postoperative pain outcomes of two different medications used in DPNB plus PRB. We thus carried out a prospective study of patients with erectile dysfunction who underwent "de novo" IPP placement between January 2013 and June 2013. Patients were divided to one of three groups: 1-DPNB plus PRB with bupivacaine injection; 2-DPNB plus PRB with ropivacaine injection and, 3-Control group without DPNB or PRB injection. Postoperative pain score and pain medication usage were recorded 2 h postoperatively, and every 24 h, for a week. The Visual Analog Scale (VAS) was used as pain scale measurement. A total of 131 patients were included in this study: 40 to bupivacaine, 47 to ropivacaine, and the rest were controls. Two hours postoperatively, mean VAS was significantly different (p < 0.0001) between medicated patients and the control group, however, no significant differences were observed between medication groups. Mean VAS was not significantly different among the groups from post-surgical day 2 thru 7. In conclusion, DPNB plus PRB during IPP provided effective analgesia in the immediate post-operative recovery.

Field evaluation of the safety, acceptability, and feasibility of early infant male circumcision using the AccuCirc device.

BackgroundAs countries scale up adult voluntary medical male circumcision (VMMC) for HIV prevention, they are looking ahead to long term sustainable strategies, including introduction of early infant male circumcision (EIMC). Although a number of devices for EIMC are prequalified by the World Health Organization, evaluation of additional devices can provide policy-makers and clinicians the information required to make informed decisions. We undertook a field evaluation of the safety and acceptability of the AccuCirc device in Kisumu County, Kenya.MethodsProcedures were performed by four trained clinicians in two public facilities. Participants were recruited from surrounding public health facilities through informational talks at antenatal clinics, maternity wards, and maternal neonatal child health clinics. Healthy infants ages 0–60 days, with no penile abnormality, without a family history of bleeding disorder, with current weight-for-age within –2 Z-scores of WHO growth standards, and whose mother was at least 16 years of age were eligible for EIMC. The procedure was performed after administration of a penile dorsal nerve block using 2% lidocaine and administration of Vitamin K. The mother was given post-operative instructions on wound care and asked to remain in the clinic with the baby for an observational period of one hour, during which a face-to-face questionnaire was administered.ResultsOf 1259 babies screened, 704 were enrolled and circumcised. Median age of the infants was 16 days (IQR: 7–32.5) and of the mothers was 26 years (IQR: 22–30). Median time for the procedure was 19 minutes (IQR: 15–23). There were no serious adverse events (AE), and 20 (2.8%) moderate AEs, all of which were due to bleeding that required application of one to three sutures. There were 22 (3.8%) procedures in which the device did not fully incise the entire circumference of the foreskin and had to be completed using sterile scissors. 89.9% of mothers had knowledge of EIMC, but few (8.1%) had any knowledge of devices used for EIMC. Protection against HIV/AIDS was the most cited reason to circumcise a baby (65.3%), while the baby being ill (38.1%) and pain (34.4%) were the most cited barriers to uptake. 99% of mothers were “very satisfied” or “completely satisfied” with the procedure.ConclusionsThis evaluation of the AccuCirc device is the largest to date and indicates that the device is safe and acceptable, achieving high levels of parental satisfaction. The AccuCirc device should be considered for WHO prequalification to increase options for safe and sustainable provision of EIMC.

The frequency spectrum of bladder non-voiding activity as a trigger-event for conditional stimulation: Closed-loop inhibition of bladder contractions in rats.

To test the hypothesis that the frequency of bladder non-voiding contractions (NVCs) can be used as a trigger event for closed-loop conditional inhibition of detrusor contractions via tibial nerve (TN) or dorsal penile nerve (DPN) stimulation. In urethane anaesthetized male Wistar rats, the bladder was filled continuously with saline to evoke contractions. To test the plausibility of conditional inhibition via the TN, electrical stimulation was switched on manually when the pressure increased above a threshold of 10 cmH2 0 above the baseline. For testing conditional stimulation via the DPN, the pressure signal was continuously stored and a baseline threshold, the area under the curve (AUC) of the amplitude spectrum in the 0.2-20 Hz range of a 5 s window at the beginning of filling was calculated. When the AUC of subsequent pressure windows superseded the baseline threshold, the DPN was automatically stimulated. TN stimulation failed to inhibit evoked voiding contractions. The NVC frequency spectrum based DPN stimulation successfully inhibited 70% of the evoked contractions and resulted in a 45% increase in bladder capacity (BC). While, conditional TN stimulation failed to suppress bladder contractions, DPN stimulation, automatically triggered by an increased frequency of bladder non-voiding activity, resulted in bladder inhibition, and a consequential increase in BC. This study demonstrates the plausibility of using the frequency of NVCs as a trigger event for conditional inhibition of detrusor contractions.

NNOS-positive minor-branches of the dorsal penile nerves is associated with erectile function in the bilateral cavernous injury model of rats

The changes in neuronal nitric oxide synthases (nNOS) in the dorsal penile nerves (DPNs) are consistent with cavernous nerve (CN) injury in rat models. However, the anatomical relationship and morphological changes between the minor branches of the DPNs and the CNs after injury have never been clearly explored. There were forty 12 week old male Sprague-Dawley rats receiving bilateral cavernous nerve injury (BCNI). Erectile function of intracavernous pressure and mean arterial pressure were measured. The histology and ultrastructure with H&E stain, Masson’s trichrome stain and immunohistochemical stains were applied on the examination of CNs and DPNs. We demonstrated communicating nerve branches between the DPNs and the CNs in rats. The greatest damage and lowest erectile function were seen in the 14th day and partially recovered in the 28th day after BCNI. The nNOS positive DPN minor branches’ number was significantly correlated with erectile function. The sub-analysis of the number of nNOS positive DPN minor branches also matched with the time course of the erectile function after BCNI. We suggest the regeneration of the DPNs minor branches would ameliorate the erectile function in BCNI rats.

Analysis of the analgesic effect and safety of dexmedetomidine combined with dorsal penile nerve block in children with circumcision

Objective To investigate the effect and safety of dexmedetomidine combined with dorsal penile nerve block for circumcision in children. Methods 130 children with circumcision were divided into the observation group and the control group according to the digital table, 65 cases in each group. The control group received total inhalation of seven halothane anesthesia, and the observation group received dexmedetomidine combined with dorsal penile nerve block anesthesia. The efficacy and safety of the two groups were compared. Results In the observation group after induction, the mean arterial pressure[(69.89±5.24)mmHg], awake and mean arterial pressure[(70.14±5.30)mmHg], rhythm of the heart after induction[(100.36±10.67)times/min], the rhythm of the heart when they woke up[(102.64±10.58)times/min], blood oxygen saturation after induction[(98.25±0.63)%], awake and blood oxygen saturation[(98.64±0.66)%]and other signs of vital signs had no statistically significant differences compared with the control group(F=0.130, 0.215, 0.548, 0.613, 0.106, 0.257, all P>0.05). In the observation group, the eyelash reflex disappearing time, operation time, awakening time were(23.16±2.13)s, (9.70±1.24)min, (10.03±1.27)min, respectively, which in the control group were(27.98±3.87)s, (11.88±2.87)min, (11.89±3.87)min, respectively, there were statistically significant differences between the two groups(t=8.797, 5.621, 6.633, all P<0.05). In the observation group, the postoperative agitation score, sedation score, pain score were(2.75±1.25)points, (1.11±0.13)points, (5.26±1.44)points, respectively, which in the control group were(6.78±2.89)points, (1.11±0.13)points, (8.97±3.64)points, respectively, there were statistically significant differences between the two groups(t=10.318, 17.236, 10.318, all P<0.05). Conclusion Application of dexmedetomidine combined with penile dorsal nerve block anesthesia in pediatric circumcision takes effect quickly, children with stable vital signs, less postoperative agitation, it is worthy of popularization and application in clinic. Key words: Circumcision, male; Penis; Nerve block; Dexmedetomidine; Child

Pancreatic kininogenase improves erectile function in streptozotocin-induced type 2 diabetic rats with erectile dysfunction.

Erectile dysfunction (ED) associated with type 2 diabetes is a severe problem that requires effective treatment. Pancreatic kininogenase (PK) has the potential to improve the erectile function of ED patients. This study aims to investigate the effect of PK on erectile function in streptozotocin-induced type 2 diabetic ED rats. To achieve this goal, we divided male Sprague–Dawley rats into five groups. One group was not treated, and the other four groups were treated with saline, sildenafil, PK or sildenafil, and PK, respectively, for 4 weeks after the induction of type 2 diabetic ED. Then, intracavernous pressure under cavernous nerve stimulation was measured, and penile tissue was collected for further study. Endothelial nitric oxide synthase levels, smooth muscle content, endothelium content, cyclic guanosine monophosphate (cGMP) levels in the corpus cavernosum, and neuronal nitric oxide synthase levels in the dorsal penile nerve were measured. Improved erectile function and endothelium and smooth muscle content in the corpus cavernosum were observed in diabetic ED rats. When treating diabetic ED rats with PK and sildenafil at the same time, a better therapeutic effect was achieved. These data demonstrate that intraperitoneal injection of PK can improve erectile function in a rat model of type 2 diabetic ED. With further research on specific mechanisms of erectile function improvement, PK may become a novel treatment for diabetic ED.

Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial.

There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities. This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time. Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB (P = .009 and P = .002, respectively). Interrater reliability was κ = 0.843. Significant increase in heart rate (139.27 [9.63] to 163 [13.23] beats per minute) and crying time (5.78 [6.4] to 45.37 [12.39] seconds) were noted in the EMLA group. During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream.

Comparison of Intraoperative and Early Postoperative Outcomes of Caudal vs Dorsal Penile Nerve Blocks for Outpatient Penile Surgeries

To compare intraoperative and 1-hour postoperative outcomes in caudal vs dorsal penile nerve block (DPNB) patients undergoing penile surgeries. We performed a retrospective cohort study of boys <10 years old undergoing penile procedures (2013-2015) using the Pediatric Regional Anesthesia Network, Pediatric Health Information System databases, and our medical records. The primary outcome was a maximum Faces Limbs Activity Crying Consolability pain score of >3. Secondary outcomes were intraoperative-postanesthesia care unit (PACU) narcotics, preincision anesthesia time, adjusted operating room charges, and complications. We performed bivariate and multivariable analyses controlling for demographic and procedural characteristics and clustering by surgeon. Of 738 patients (mean age 2.1 years), 74.1% had a caudal block. DPNB patients were more likely to have a maximum pain score of >3 (19.5% vs 8.1%, P <.0001), receive intraoperative (33.0% vs 2.9%, P <.0001) and PACU (15.7% vs 7.5%, P = .0009) narcotics, and had shorter preincision anesthesia times (19.5 vs 27.9 minutes, P <.0001) and lower adjusted operating room charges ($9,402 vs $12,760, P <.0001). In a bivariate logistic regression, DPNB patients had 2.7 times the odds of a maximum pain score of >3 (95% confidence interval 1.7-4.4, P <.0001) and 5.2 times the odds of intraoperative and PACU narcotic administration (95% confidence interval 3.3-8.1, P <.0001). In multivariable analyses, caudal patients had longer preincision anesthesia times (27.9 ± 7.4 vs 19.5 ± 6.6 minutes, P <.0001) and higher adjusted operating room charges ($12,760 ± 4077 vs $9,402 ± 3741, P = .01). Caudal blocks may offer a small advantage in the immediate postoperative period, although cost-effectiveness is unproven.

Spontaneous Regeneration of Nerve Fiber and Irreversibility of Corporal Smooth Muscle Fibrosis After Cavernous Nerve Crush Injury: Evidence From Serial Transmission Electron Microscopy and Intracavernous Pressure

To determine the pathophysiological progresses following bilateral cavernous nerve crushing injury, as an index for a treatment point and establishment of adequate treatment strategies for neurogenic erectile dysfunction. Thirty-six rats were assigned to 1 of 6 groups, and bilateral cavernous nerve crushing or sham surgery was performed. Functional testing and ultrastructural analyses were performed immediately and at 7, 14, 21, and 28 days after the cavernous nerve (CN) injury (n = 6). Intracavernos pressure lowered progressively from 7 days to 14 days post-injury, and histologic staining revealed that the number of neuronal nitric oxide synthase-positive nerve fibers on the dorsal penile nerve decreased significantly and progressively from 7 days until 21 days post-injury. Furthermore, ultrastructural analyses revealed axon loss and demyelination of the CN at 7 and 14 days post-injury. However, it is followed by partial spontaneous recovery of erectile function and regeneration of the CN at 28 days post-injury, suggesting that these time points may be useful for evaluating the effects of drug treatments. Furthermore, we found that CN injury-induced damage to corporal smooth muscle cells was irreversible; therefore, focusing on protecting the corpus cavernosum from apoptosis may be more important than nerve protection when assessing treatment mechanisms in the CN injury model. Our study makes a significant contribution to the human diagnostic pathology literature because it describes characteristics of relevant tissue in the rat and provides information regarding time points that may be useful for future studies of pathologic mechanisms or treatment evaluations.

The effect of cavernous nerve traction on erectile function in rats.

We performed this study to evaluate the effect of cavernous nerve (CN) traction on erectile function in rats. Thirty-two 8- week-old Sprague–Dawley rats were divided into four groups: control, 1-minute CN traction, 2-minute CN traction, and 2-minute CN crush. CN traction was performed using a glass hook with a tensile force of 0.2 Newton. One month later, the mean arterial pressure (MAP) and intracavernosal pressure (ICP) in response to CN stimulation were measured to assess erectile function. The penis and major pelvic ganglion (MPG) were harvested to explore the expression of neuronal nitric oxide synthase (nNOS) and neurofilament, fibrosis and apoptosis. The ICP/MAP ratio was reduced in the 2-minute CN traction group compared with the control group (P < 0.05). The ICP/MAP ratio in the CN crush group was lower than in the other three groups (P < 0.05, for each). Expression of nNOS in both MPG and dorsal penile nerve was lower in the CN traction group than in the control group, but was higher than in the CN crush group (P < 0.05). Nerve fiber number in the dorsal penile nerve was reduced by 2-minute CN traction (P < 0.05). The ratios of collagen to smooth muscle content and the apoptosis were both increased the in 2-minute CN traction group compared with the control group (P < 0.05). The findings indicate that CN traction is an effective CN injury model and the injury it caused is relatively mild compared with the CN crush model.

Effect of lidocaine combined with ropivacaine in penile dorsal nerve block for pediatric circumcision

Objective To explore the effect of lidocaine combined with ropivacaine in penile dorsal nerve block for pediatric circumcision. Methods 130 children with pediatric circumcision surgery were divided into observation group and control group by the digital meter method, 65 cases in each group.The control group was taken inhaled sevoflurane composite static note ketamine surgery, the observation group was given ropivacaine combined with intravenous infusion of ketamine for penile dorsal nerve block anesthesia.The anesthesia effects of the two groups were recorded. Results In the observation group, 10 min after surgery, the rhythm of the heart was (98.47±10.88)times/min, central arterial pressure was (65.13±7.78)mmHg.In the control group, 10min after surgery, the rhythm of the heart was (121.78±15.23)times/min, central arterial pressure was (85.27±12.31)mmHg, the differences between the two groups were statistically significant(t=10.040, 11.150, all P<0.05). In the observation group, the used ketamine, waking up time, pain score, incidence rate of pain and irritability were (41.38±11.28)mg, (5.54 ±1.03)min, (2.11±1.13)points, 7.69%, respectively, which in the control group were (71.47±16.82)mg, (13.67±2.57)min, (3.89±1.79)points, 26.15%, respectively, the differences between the two groups were statistically significant(t=11.978, 23.673, 6.779, χ2=7.878, all P<0.05). Conclusion The anesthesia effect of lidocaine combined with ropivacaine in penile dorsal nerve block for pediatric circumcision is stable, safe and reliable, it is worthy of popularization and application in clinic. Key words: Circumcision, Male; Nerve Block; Penis; Child

Abstract: New Treatment of Erectile Dysfunction Post-Radical Prostatectomy Using Nerve Grafts and End-to-Side Neurorraphies

INTRODUCTION: Radical prostatectomy (RP) for prostate cancer treatment, although effective, can lead to severe erectile dysfunction. This study describes a new technique, which aims to reestablish the nerve stimulus in penile erection via two sural nerve graft bridges, bilaterally. OBJECTIVE: To study a novel penile reinnervation technique between the femoral and cavernous corpus and dorsal penile nerves via sural nerve grafts and end-to-side neurorraphies. METHODS: Ten patients with a mean age of 60.3 ± 4.8 years (54 – 68) who had undergone RP at least two years previously were submitted to penile reinnervation. Four patients had undergone radiotherapy following RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire, Pharmacopenile Doppler Ultrassonography (PPDU) at pre-op, 6, 12 and 18 months post-op, and by a clinical evolution of erectile function (CEEF) questionnaire during 36 months. RESULTS: IIEF presented improvements for erectile dysfunction, satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between right and left sides or between the allocated time periods. The introduction of nerve grafts did not cause fibrosis of the corpus cavernosum, nor did it lead to a reduced penile vascular flow. Regarding CEEF, sexual intercourse began after 13.7 months, with frequency of sexual intercourse (SI) varying from once daily to once monthly. CONCLUSION: Sixty percent of cases achieved full penetration, on average, thirteen months after reinnervation surgery. One may observe that patients previously submitted to radiotherapy presented slower recuperation of erectile function. One may conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer itself as a new treatment modality for erectile dysfunction following radical prostatectomy.

AB013. Diagnosis and treatment of premature ejaculation

The definition of premature ejaculation has not yet been agreed upon in the international community, which can be divided into primary premature ejaculation, secondary premature ejaculation, variability premature ejaculation and premature ejaculation likely erectile dysfunction. The diagnosis can be carried out based on the patient’s medical history, the sexual evaluation table and the neurological examination of the premature ejaculation in China, Neurologic examination including the sensory evoked potentials of the penile dorsal nerve (DNSEP) and the sensory evoked potentials of the penis glans (GPSEP). Treatment methods can choose psychological counseling, behavioral therapy, drug therapy and surgical treatment. Drug therapy including topical drugs, serotonin reuptake inhibitors (SSRi), receptor blockers, type 5 phosphodiesterase inhibitors (PDE5i), etc., of the latest medications can choose hydrochloric acid of dapoxetine (Priligy) treatment.

MP41-14 HUMAN URINE-DERIVED STEM CELLS GENETICALLY-MODIFIED WITH PEDF IMPROVE CAVERNOUS NERVE INJURY-INDUCED ERECTILE DYSFUNCTION IN A RAT MODEL

You have accessJournal of UrologyStem Cell Research1 Apr 2017MP41-14 HUMAN URINE-DERIVED STEM CELLS GENETICALLY-MODIFIED WITH PEDF IMPROVE CAVERNOUS NERVE INJURY-INDUCED ERECTILE DYSFUNCTION IN A RAT MODEL Qiyun Yang, Xin Chen, Tao Zheng, Kai Xia, Xiangzou Sun, Guihua Liu, Yuanyuan Zhang, and Chunhua Deng Qiyun YangQiyun Yang More articles by this author , Xin ChenXin Chen More articles by this author , Tao ZhengTao Zheng More articles by this author , Kai XiaKai Xia More articles by this author , Xiangzou SunXiangzou Sun More articles by this author , Guihua LiuGuihua Liu More articles by this author , Yuanyuan ZhangYuanyuan Zhang More articles by this author , and Chunhua DengChunhua Deng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1282AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to investigate whether intracavernous injection of urine-derived stem cells (USCs) or USCs overexpressing pigment epithelium-derived factor (PEDF) could protect the erectile function and cavernous structure in a bilateral cavernous nerve injury-induced erectile dysfunction (CNIED) rat model. METHODS USCs were cultured from the urine of eight healthy male donors. Seventy-five rats were randomly divided into five groups (n = 15 per group): sham, bilateral cavernous nerve (CN) crush injury (BCNI), USC, GFP-USC , and PEDF-USC groups. The sham group received only laparotomy without CN crush injury and intracavernous injection with phosphate-buffered saline (PBS). All of the other groups were subjected to BCNI and intracav- ernous injection with PBS, USCs, GFP-USCs, or GFP/PEDF-USCs, respectively. The total intracavernous pressure (ICP) and the ratio of ICP to mean arterial pressure (ICP/MAP) were recorded. The penile dorsal nerves, the endothelium, and the smooth muscle were assessed within the penile tissue. RESULTS The penile dorsal nerves, the endothelium, and the smooth muscle were assessed within the penile tissue. The USC and PEDF-USC groups displayed more significantly enhanced ICP and ICP/MAP ratio (p < 0.05) 28 days after cell transplantation. Immunohistochemistry (IHC) and Western blot analysis demonstrated that the protection of erectile function and the cavernous structure by PEDF-USC was associated with an increased number of nNOS-positive fibers within the penile dorsal nerves, improved expression of endothelial markers (CD31 and eNOS) and smoothelin, an enhanced smooth muscle to collagen ratio, decreased expression of TGF-b1, and decreased cell apoptosis in the cavernous tissue. CONCLUSIONS The paracrine effect of USCs and PEDF-USCs prevented the destruction of erectile function and the cavernous structure in the CNIED rat model by nerve protection, thereby improving endothelial cell function, increasing the smooth muscle content, and decreasing fibrosis and cell apoptosis in the cavernous tissue. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e541 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Qiyun Yang More articles by this author Xin Chen More articles by this author Tao Zheng More articles by this author Kai Xia More articles by this author Xiangzou Sun More articles by this author Guihua Liu More articles by this author Yuanyuan Zhang More articles by this author Chunhua Deng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term follow-up of treatment of erectile dysfunction after radical prostatectomy using nerve grafts and end-to-side somatic-autonomic neurorraphy: a new technique.

To study a novel penile reinnervation technique using four sural nerve grafts and end-to-side neurorraphies connecting bilaterally the femoral nerve and the cavernous corpus and the femoral nerve and the dorsal penile nerves. Ten patients (mean [± sd; range] age 60.3 [± 4.8; 54-68] years), who had undergone radical prostatectomy (RP) at least 2 years previously, underwent penile reinnervation in the present study. Four patients had undergone radiotherapy after RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire and pharmaco-penile Doppler ultrasonography (PPDU) preoperatively and at 6, 12 and 18 months postoperatively, and using a Clinical Evolution of Erectile Function (CEEF) questionnaire, administered after 36 months. The IIEF scores showed improvements with regard to erectile dysfunction (ED), satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between the right and left sides or among the different time points. The introduction of nerve grafts neither caused fibrosis of the corpus cavernosum, nor reduced penile vascular flow. CEEF results showed that sexual intercourse began after a mean of 13.7 months with frequency of sexual intercourse varying from once daily to once monthly. Acute complications were minimal. The study was limited by the small number of cases. A total of 60% of patients were able to achieve full penetration, on average, 13 months after reinnervation surgery. Patients previously submitted to radiotherapy had slower return of erectile function. We conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer a new treatment method for ED after RP.

250 - Role of low-intensity shock wave therapy in penile rehabilitation post nerve sparing radical cysto-prostatectomy: A prospective randomized controlled trial

250 - Role of low-intensity shock wave therapy in penile rehabilitation post nerve sparing radical cysto-prostatectomy: A prospective randomized controlled trial

Activation of galanin and cholecystokinin receptors in the lumbosacral spinal cord is required for ejaculation in male rats.

The spinal ejaculation generator is comprised of lumbar spinothalamic (LSt) cells and their axonal projections to autonomic and motor neurons in the lumbosacral spinal cord. LSt cells regulate ejaculatory reflexes by release of neuropeptides that are co-expressed in their axons, as previously demonstrated for gastrin-releasing peptide and enkephalin. Here, the role of two other neuropeptides co-expressed in LSt cells for ejaculatory reflexes is demonstrated: galanin and cholecystokinin (CCK). Adult male rats were anesthetized, spinalized, and received intrathecal infusions of galanin receptor antagonist Galantide (1 or 10nmol) or CCK receptor antagonist proglumide (71 or 714nmol). The dorsal penile nerve (DPN) was electrically stimulated to trigger ejaculatory reflexes and seminal vesicle pressure (SVP) and rhythmic contractions of the bulbocavernosus muscle (BCM) were analyzed as parameters of emission and expulsion respectively. Treatment with galanin or CCK antagonists significantly reduced SVP increases and BCM bursting, demonstrating that galanin and CCK are required for ejaculation. Next, anesthetized, spinalized males received intrathecal infusions of galanin (0.15 or 0.3nmol) or CCK(26-33) (4.35nmol) and effects on subthreshold DPN stimulations were determined. Intrathecal infusions of galanin or CCK facilitated ejaculatory reflexes induced by subthreshold DPN stimulation in all animals, but did not trigger ejaculatory reflexes in the absence of DPN stimulation. Together, these results demonstrate that galanin and CCK both act in the spinal ejaculation generator to regulate ejaculation. However, effects of galanin and CCK were dependent on DPN stimulation, suggesting that these neuropeptides may act in concert with other LSt co-expressed neuropeptides.

Ultrasound-guided penile nerve block in pediatrics: An answer to intraoperative priapism.

Ultrasound-guided penile nerve block in pediatrics: An answer to intraoperative priapism.

Transplantation of Human Urine-Derived Stem Cells Transfected with Pigment Epithelium-Derived Factor to Protect Erectile Function in a Rat Model of Cavernous Nerve Injury

The aim of this study was to investigate whether intracavernous injection of urine-derived stem cells (USCs) or USCs genetically modified with pigment epithelium-derived factor (PEDF) could protect the erectile function and cavernous structure in a bilateral cavernous nerve injury-induced erectile dysfunction (CNIED) rat model. USCs were cultured from the urine of six healthy male donors. Seventy-five rats were randomly divided into five groups ( n = 15 per group): sham, bilateral cavernous nerve (CN) crush injury (BCNI), USC, USCGFP+, and USCGFP/PEDF+ groups. The sham group received only laparotomy without CN crush injury and intracavernous injection with phosphate-buffered saline (PBS). All of the other groups were subjected to BCNI and intracavernous injection with PBS, USCs, USCsGFP+, or USCsGFP/PEDF+, respectively. The total intracavernous pressure (ICP) and the ratio of ICP to mean arterial pressure (ICP/MAP) were recorded. The penile dorsal nerves, the endothelium, and the smooth muscle were assessed within the penile tissue. The USC and USCGFP/PEDF+ groups displayed more significantly enhanced ICP and ICP/MAP ratio ( p < 0.05) 28 days after cell transplantation. Immunohistochemistry (IHC) and Western blot analysis demonstrated that the protection of erectile function and the cavernous structure by USCsGFP/PEDF+ was associated with an increased number of nNOS-positive fibers within the penile dorsal nerves, improved expression of endothelial markers (CD31 and eNOS) and a smooth muscle marker (smoothelin), an enhanced smooth muscle to collagen ratio, decreased expression of transforming growth factor-β1 (TGF-β1), and decreased cell apoptosis in the cavernous tissue. The paracrine effect of USCs and USCsGFP/PEDF+ prevented the destruction of erectile function and the cavernous structure in the CNIED rat model by nerve protection, thereby improving endothelial cell function, increasing the smooth muscle content, and decreasing fibrosis and cell apoptosis in the cavernous tissue.