Molecular pathophysiology of cavernous nerve injury and identification of strategies for nerve function recovery after radical prostatectomy.

Overview

Despite nerve-sparing techniques, erectile dysfunction remains commonly observed after radical prostatectomy due to neuropraxia to the cavernous nerves during surgery. Preservation and rehabilitation of erectile function after radical prostatectomy remains challenging and many men stay undertreated with the current armory of therapies available in clinical practice. In this article we provide a comprehensive overview of the pathophysiology of the nerve injury occurring during radical prostatectomy and describe different strategies aimed at enhancing neuroprotection and regeneration of the cavernous nerves in order to improve erectile function recovery. These strategies include immunomodulatory, neurotrophic, growth factor and stem cell therapy have convincingly shown improved erectile function and recovery in rat animal models after cavernous nerve injury. Furthermore we describe the rationale for penile rehabilitation with PDE5i out of a neuronal recovery point of view. Many of these strategies reviewed have the potential to optimize erectile function recovery after radical prostatectomy when translated from pre-clinical models to clinical practice.