Neuromodulatory therapy to improve erectile function recovery outcomes after pelvic surgery

Purpose: Erectile dysfunction is a recognized, common adverse consequence of radical prostatectomy as well as various other pelvic surgeries. While a host of management options have been considered to decrease this complication, neuromodulatory therapy has recently been advanced as an intervention that may be applied for this purpose. We evaluated concepts regarding the neuropathic basis for erectile dysfunction following pelvic surgery, principles for establishing neuromodulatory therapy in this clinical context, evidence from preclinical studies supporting neuromodulatory approaches as a therapeutic strategy and the progress of early clinical developments in this field. Materials and Methods: The exercise principally consisted of a current literature search using the National Library of Medicine PubMed Services, a survey of recent abstract proceedings from national meetings relevant to the topic and an Internet online search for current information on federally and privately supported clinical trials specific to this topic. References were made to such key words as neuroprotection, nerve regeneration, nerve growth factors, neurotrophic factors, cavernous nerves, nerve guides and penile erection. Results: Basic science research and clinical studies support the concept that erectile loss after pelvic surgery is frequently related to neuropathic effects, resulting in penile vascular impairment. An assortment of neurobiological studies using rodent models of cavernous nerve injury have shown nerve reconstitutive actions for a host of neurotrophic substances, including classic neurotrophins, growth hormone, cytokines and atypical neurotrophic mediators. Clinical trials of several proposed neuroprotective and neurotrophic applications have been done or are in progress. Conclusions: Erectile dysfunction is a well recognized and yet ineffectively averted complication of pelvic surgery. Neuro-modulatory therapy offers a therapeutic approach for addressing the neuropathic changes of the penis that occurs in this context with the goal of maximally preserving erectile function postoperatively. While several specific neuromodulatory, applications have gained interest for their potential benefit with pelvic surgery, determining their actual roles awaits the completion of controlled clinical trials.