Implantable pelvic neurostimulators to restore erectile function: from concept to practice

The quest for therapeutics to manage erectile dysfunction has evolved in the past few decades, with attention now directed towards interventions that facilitate and retain natural erectile ability. Electrical neurostimulation of the penis is a technique that could meet this objective. Although only in the early stages of development, this intervention could act as an authentic restorative therapy, targeting the penile-nerve supply that is impaired by disease states, injury or ageing. The concept is in accordance with well-substantiated neuromodulatory management approaches to erectile dysfunction, aimed at promoting neuronal integrity and function of the nerves, which are essential for regulating penile erections. The use of this technique is supported by intensive research over the past 150 years, from early experimental observations of erection responses following electrical stimulation of pelvic nerves to contemporary clinical investigations showing recovery of erection after implantation of pelvic neurostimulators in men with spinal-cord injury or undergoing radical prostatectomy. Thus, this therapy could be considered an emerging subspecialty, spanning the establishment of the neuroregulatory basis of penile erection and the invention of technologies that capitalize on the science of pelvic neurophysiology. The clinical use of penile neurostimulation could, therefore, offer a revolutionary new therapeutic approach in the field of sexual medicine.