Novel Concept Enabling an Old Idea: A Flexible Electrode Array to Treat Neurogenic Erectile Dysfunction

Area of Science:

• Urology
• Neuroscience
• Biomedical Engineering

Background:

• Electrostimulation of the cavernosal nerve can induce penile erection, suggesting neurostimulation as a potential treatment for erectile dysfunction (ED).
• The complex anatomy of the cavernous nerve hinders precise electrode placement for effective neurostimulation, limiting the development of this ED treatment.
• Current neurostimulation approaches for ED face challenges due to the need for intraoperative identification of specific nerve pathways.

Purpose of the Study:

• To evaluate a novel 2-dimensional flexible electrode array designed to cover the entire pelvic plexus area for treating neurogenic erectile dysfunction.
• To assess the feasibility of achieving optimal cavernosal nerve contact without the need for intraoperative nerve identification.
• To investigate the efficacy of this flexible electrode array in inducing penile erection during radical prostatectomy procedures.

Main Methods:

• A 2-dimensional flexible electrode array was applied to the pelvic plexus of 24 patients undergoing open radical prostatectomy.
• Electrical stimulation was administered via the electrode array positioned on the prostatic apex or pelvic wall to induce penile erection.
• Penile erectile response was assessed visually for tumescence and quantitatively using a penile plethysmograph system.

Main Results:

• Electrical stimulation with the flexible electrode array produced an immediate penile response in all tested patients.
• Significant penile engorgement was observed in 75% of cases, with 25% showing minimal to moderate tumescence.
• Bilateral stimulation demonstrated a potentiated erectile response compared to unilateral stimulation (circumference increase: 8.2 ± 1.9 mm vs. 2.7 ± 1.02 mm, P = .01).

Conclusions:

• The flexible electrode array provides a proof-of-concept for a novel medical implant to treat ED resulting from nerve injury, such as after prostatectomy.
• This approach overcomes individual anatomical variability by ensuring stimulation of the erectogenic neuronal pathway.
• Further studies are required to assess the chronic efficacy of this technology for clinical application in treating neurogenic erectile dysfunction.