Does the CaverMap device help preserve potency?

Abstract

Erectile dysfunction remains a common complication following radical prostatectomy. The CaverMap Surgical Aid (UroMed, Boston, MA) was designed to aid the surgeon in identifying and preserving neurovascular bundles (NVBs). However, the size of the CaverMap nerve stimulator may make it difficult to trace the cavernous nerves before the prostate is removed, particularly in obese men or in patients who have a large prostate or a narrow pelvis. In a randomized, controlled study, the use of the CaverMap during radical prostatectomy resulted in improved nocturnal erections, but did not lead to improved overall sexual function. The CaverMap device, however, may be useful as a research tool in that it helps determine whether the NVBs have been successfully preserved after removing the prostate. However, preservation of the NVB does not guarantee recovery of potency, which may be prolonged despite successful stimulation of the cavernous nerves intraoperatively. This suggests that erectile dysfunction following radical prostatectomy is multifactorial.

Electrical stimulation vs. pulsed and continuous-wave optical stimulation of the rat prostate cavernous nerves, in vivo

“…Electrical nerve stimulation (ENS) mapping techniques been tested extensively in the clinic as a potential intraoperative tool for identification of the CNs during prostate surgery [11][12][13][14][15][16]. However, ENS has proven to be inconsistent and unreliable in identifying CNs.…”

“…However, ENS has proven to be inconsistent and unreliable in identifying CNs. Lack of specificity, high false positive responses, and the influence of multiple conflicting factors in recording an ENS response during surgery are reported limitations [13][14][15][16]. ENS in general has several limitations, such as the need for physical contact between the electrode and tissue, poor spatial precision due to spread of electrical current in tissue, and electrical artifacts that may interfere with measurements [17,18].…”

Novel methods for mapping the cavernous nerves during radical prostatectomy

“…[15][16][17][18][19][20][21] The most common of these devices is the Cavermap® (Blue Torch Medical Technologies, USA) surgical aid, which utilizes electrical stimulation to elicit an erectile response in the form of penile tumes cence. The Cavermap® measures small changes in penile circumference during electrical stimulation, through use of a sensor placed around the penis.…”

“…Low specificity and high falsepositive response rates have been frequently cited as limitations of this technique. [18][19][20][21] Furthermore, ENS based techniques in general suffer from several inher ent limitations, including the need for physical contact between the electrode and the tissue, poor spatial pre cision owing to electrical current spreading in tissue and electrical artefacts that can interfere with measure ment. As a result, Cavermap® has not been adapted on a w idespread basis for use in the clinic.…”

The Effects of Cavernous Nerve Grafting following Surgically Induced Loss of Erectile Function in a Large-Animal Model

“…A number of studies have supported the clinical efficacy of the CaverMap system to assist in cavernous nerve preservation. [42][43][44][45][46] However, other studies have questioned the usefulness of direct electrical stimulation and have recommended further refinements to the system. 47,48 In this study, direct stimulation was limited by anatomical restrictions associated with the sensor placement on the canine penis and an inability to quantify the erectile response with sequential ablation or at the time of cavernous nerve harvest.…”