Cavernous Nerve Reconstruction During Radical Prostatectomy by Sural Nerve Grafting: Surgical Technique in Nerve Harvesting and Grafting

Muneuchi, Gan; Kuwata, Yoshihiro; Taketa, Shigeo; Inui, Masashi; Tsukuda, Fumio; Shimada, Osamu; Igawa, Hiroharu H.; Kakehi, Yoshiyuki

doi:10.1055/s-2005-922430

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…Recently, Muneuchi et al. reported their successful work on repair of excised neurovascular bundles with autologous sural nerve grafts [23]. However, obtaining the sural nerve requires another complicated operation and will inevitably compromise the function of corresponding muscle.…”

Section: Discussionmentioning

confidence: 99%

Erectile Function Restoration After Repair of Excised Cavernous Nerves by Autologous Vein Graft in Rats

Cheng

Liu

et al. 2010

The Journal of Sexual Medicine

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Introduction Cavernous nerves (CNs) injury is the main cause of erectile dysfunction (ED) following radical prostatectomy. Its restoration remains challenging. Aim To investigate the feasibility of erectile function recovery by autologous vein graft after bilateral CNs being excised in a rat model. Methods A total of 36 adult male Sprague-Dawley rats were randomized into three groups. A 5 mm segment of CN was excised bilaterally in group B and C. In group B, a 7-mm segment of autologous saphenous vein was interposed at the defect site bilaterally, with two nerve stumps inserted into the vein lumen. Group C underwent no repair. Group A was accepted a sham operation. 4 months later, apomorphine tests were performed on each rat, followed by injection of 4% fluorogold into bilateral corpus cavernous. 5 days later, after monitoring intracorporal pressure (ICP) changes induced by electrostimulation of CN, rats were sacrificed and their bilateral major pelvic ganglions were obtained for detection of fluorogold, and penile tissues of middle shaft were obtained for detecting nitric oxide synthase-containing nerve fibers in penile dorsal nerves. Main Outcome Measures Erectile function was assessed by apomorphine test and ICP monitoring. CN regeneration was judged by fluoroglod tracing and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase staining. Results Apomorphine tests resulted in 58% rats with erectile responses in group B, whereas no erection was observed in group C. ICP monitoring also demonstrated a significant recovery in erectile function in group B compared with group C. Much more and brighter fluorogold coloring cells were examined in major pelvic ganglions of group B than those of group C. NADPH-diaphorase staining also showed much more positive fibers were detected in penile dorsal nerves in group B than in group C. Conclusion Autologous vein graft could provide a guide channel to induce CN regeneration and successfully restore autonomic erectile function after CNs being excised in rats.

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Section: Discussionmentioning

confidence: 99%

Erectile Function Restoration After Repair of Excised Cavernous Nerves by Autologous Vein Graft in Rats

Cheng

Liu

et al. 2010

The Journal of Sexual Medicine

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“…As a result, many researchers have been focusing on this area 49 . Muneuchi et al 50 investigated the effects of autologous sural nerve grafts to repair injured neurovascular bundles, and they observed positive results. However, it's a complex procedure to prepare a sural nerve graft, and the structure and function of the corresponding muscle may deteriorate.…”

Section: Introductionmentioning

confidence: 99%

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

Asker

Yilmaz‐Oral

Öztekin³

et al. 2022

The Prostate

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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.

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Nerve Grafting at Radical Retropubic Prostatectomy: Rationale, Technique, and Results

Pettus

Rabbani

2009

Sexual Function in the Prostate Cancer Patient

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Cavernous Nerve Reconstruction During Radical Prostatectomy by Sural Nerve Grafting: Surgical Technique in Nerve Harvesting and Grafting

Cited by 6 publications

References 8 publications

Erectile Function Restoration After Repair of Excised Cavernous Nerves by Autologous Vein Graft in Rats

Erectile Function Restoration After Repair of Excised Cavernous Nerves by Autologous Vein Graft in Rats

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

Nerve Grafting at Radical Retropubic Prostatectomy: Rationale, Technique, and Results

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