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Published on: April 23, 2018
The effects of cavernous nerve grafting following surgically induced loss of erectile function in a large-animal
James B Lowe1, Daniel A Hunter, Michael R Talcott
1Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, USA. drjimlowe@sbcglobal.net
Background:
Prostate cancer is the second most common cause of cancer deaths in men in the United States. Many patients experience partial or complete loss of erectile function following prostatectomy. The cavernous nerves can be reconstructed intraoperatively using sural nerve grafts in an attempt to restore erectile function.
Methods:
In this study, multiple anatomical dissections and neurologic assessments were used to define the position and histologic parameters of the cavernous nerve in a canine model. The subsequent experimental design included three groups of adult mongrel dogs followed for an 8-month period. Group 1, the control group, underwent bilateral nerve ablation to substantiate surgically induced loss of erectile function. Group 2, the "sham" group, underwent exploration only. Group 3 underwent bilateral cavernous nerve ablation with bilateral sural nerve graft reconstruction. Erectile function was evaluated with indirect electrical nerve and manual penile stimulation preoperatively and 1, 2, 4, 6, and 8 months postoperatively. Direct nerve stimulation and histologic analysis was preformed at the first operation and at the time the animals were euthanized at 8 months.
Results:
Bilateral cavernous nerve ablation resulted in a significant loss of erectile function for 8 months postoperatively in the control animals. The sham animals demonstrated preservation of erectile function immediately following exploration. The animals in the grafted group demonstrated a significant return of erectile function by 4 months compared with preoperative measurements and by 2 months compared with control animals.
Conclusions:
This study establishes the first large-animal model for surgically induced loss of erectile function with successful cavernous nerve graft reconstruction, and it provides the unique opportunity to explore the effects of changes to this model in the future.
Insights
Sural nerve grafts successfully restored erectile function in a canine model after prostatectomy-induced nerve damage. This study provides a new large-animal model for future research into erectile dysfunction treatments.
Area of Science:
- Urology
- Regenerative Medicine
- Animal Models
Background:
- Prostate cancer is a leading cause of cancer deaths in men.
- Radical prostatectomy often results in erectile dysfunction due to cavernous nerve damage.
- Sural nerve grafts offer a potential solution for intraoperative cavernous nerve reconstruction.
Purpose of the Study:
- To establish a large-animal model for surgically induced erectile dysfunction.
- To evaluate the efficacy of sural nerve grafts in reconstructing cavernous nerves.
- To assess the restoration of erectile function following nerve grafting.
Main Methods:
- Anatomical dissections and neurologic assessments in a canine model.
- Three groups: bilateral cavernous nerve ablation (control), sham surgery, and nerve grafting.
- Erectile function evaluation via electrical and manual penile stimulation over 8 months.
Main Results:
- Bilateral cavernous nerve ablation caused significant erectile dysfunction.
- Sham surgery preserved erectile function.
- Sural nerve grafting led to significant erectile function return by 4 months postoperatively.
Conclusions:
- This study presents the first large-animal model for surgically induced erectile dysfunction with successful cavernous nerve graft reconstruction.
- The model allows for future exploration of therapeutic interventions.
- Demonstrates the potential of sural nerve grafts for restoring erectile function.
