Arthur L. Burnett II, MD, MBA, FACS, presented “New Frontiers in Cavernous Nerve Restorative Therapy to Preserve Erectile Function after Radical Prostatectomy” during the Jackson Hole Seminars on January 31, 2019 in Jackson Hole, Wyoming.
How to cite: Burnett II, Arthur L. “New Frontiers in Cavernous Nerve Restorative Therapy to Preserve Erectile Function after Radical Prostatectomy” January 31, 2019. Accessed [date today]. https://new-frontiers-in-cavernous-nerve-restorative-therapy-to-preserve-erectile-function-after-radical-prostatectomy/
New Frontiers in Cavernous Nerve Restorative Therapy to Preserve Erectile Function after Radical Prostatectomy – Summary
Arthur L. Burnett II, MD, MBA, FACS, presents the rationale for invoking therapeutic strategies for enhancing erectile function recovery following radical prostatectomy. He assesses possible therapeutic strategies that target the cavernous nerve in order to restoring erectile function and identifies the requirements and future possibilities for penile rehabilitation success.
While radical prostatectomy (RP) does offer excellent long-term rates of prostate cancer control, erectile dysfunction (ED) remains a significant complication of the surgery. Although cavernous nerve-sparing techniques have reduced ED to 15-40%, there remains an interest in and a need to improve erectile function recovery rates. Patients may still experience neuropathy despite nerve-sparing surgery due to other factors, including factors on the molecular and genetic levels.
In regard to the current state of managing RP-related ED, there have been refinements in nerve-sparing techniques, including early release of the neurovascular bundles, prostatic fascia-sparing, and high release of the endopelvic fascia with “interfascial dissection.”
Previously, the paradigm of managing ED involved a process of care with patients progressing from first- to third-line therapies based on degrees of invasiveness, ranging from oral PDE5 inhibitors to penile prosthesis surgery. Now, the American Urological Association (AUA) has described a shared decision-making model in which all options can be a potential first-line treatment depending upon the scenario and preferences of the patient. Although PDE5 inhibitors may be successful in the context of treatment on demand to achieve an erection response, data is inconclusive regarding their efficacy in rehabilitating natural, spontaneous erections.
There are still limited options physicians can offer to meet patient expectations of recovery rates due to lack of level 1 evidence-based medicine. However, there are efforts being made to achieve optimal functional outcomes following RP. These efforts include investigations into agents with potential benefit for neuroprotection, especially erythropoietin, nerve regeneration strategies, and electric stimulation of the cavernous nerve.
In the future, it is imperative that we continue rigorous scientific investigation, including the conduction of controlled clinical trials, in order to improve future progress.
About the Ralph E. Hopkins Urology Seminar
The Ralph E. Hopkins Urology Seminar, or Jackson Hole Seminars (JHS), is a multi-day conference that focuses on patient safety and cutting-edge updates in the assessment, diagnosis, and treatment of urologic conditions. The topics discussed include urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. In addition to didactic expert lectures, this conference features a unique interactive critique panel. Dr. Burnett presented this lecture during the 39th Annual JHS. Please visit this page in order to register for future JHS meetings.