An update on the current status and future prospects of erectile dysfunction following radical prostatectomy

Abstract

Background: Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies. Objective: This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research. Method: Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database. Results: Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies. Conclusion: This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, lowintensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.

Research Advances in Stem Cell Therapy for Erectile Dysfunction

“…However, the treatment outcomes are poor compared with those in the general ED population [ 10 ]. Several studies have now demonstrated the ability of stem cell therapy to improve nerve injury ED and reduce patients’ dependence on PDE5 inhibitors [ 11 ], with therapeutic effects varying by stem cell source (Supplementary Table 1).…”

Reviving intimacy: Penile rehabilitation strategies for men after prostate cancer treatment

“…In an animal study, ADSC-derived exosomes and bone marrow-derived, and MSC-derived exosomes reduced pathological alterations in neural anatomy, smooth muscle atrophy, endothelial injury, and collagen deposition. 68 Combining ICI of marrow-derived MSCs and oral-long term administration of PDE5i tadalafil seems to be superior in preserving the CC and endothelial tone while maintaining EF after CNI. Given a low-risk safety profile, SCT and PDE5i suggest a potential role for this dual strategy in the management of PR.…”

“…have shown that human placental stem cell treatment significantly increased in vivo erectile responses and markers of nerve, endothelial, and smooth muscle cells at the end of the 6th and 12th week in rats. 68 Due to ethical concerns, further translational research has yet to be studied in an RCT. Several positive studies for post-RP ED include intracavernous bone marrow-mononuclear cells and adipose-derived stem cells (ADSC) via ICI.…”

“… 58 , 72 COX-2-10aa-PGIS is a newly engineered protein that is considered a potent smooth muscle relaxant. 68 Lin et al., demonstrated Ad-COX2-10aa-PGIS via ICI had a beneficial effect on improving EF in BCNI rats after 28 days. 68 This improvement appears to be related to its antifibrotic and antiapoptotic mechanisms.…”

“… 68 Lin et al., demonstrated Ad-COX2-10aa-PGIS via ICI had a beneficial effect on improving EF in BCNI rats after 28 days. 68 This improvement appears to be related to its antifibrotic and antiapoptotic mechanisms. Several other studies report positive effects on CC integrity and preservation of EF when using viral capsid-mediated gene transfer of various biologics including Smad7, ADSCs, and myocardin.…”