Grid electrode technology: electrophysiological tool for cavernous nerve mapping

Sexual and urinary functional outcomes after pelvic surgeries such as radical prostatectomy remain unsatisfactory today despite advances in surgical technique. A call to action exists to explore, develop and apply adjunct technologic modalities that may bring about improvement in these outcomes. This study aimed to investigate the potential application of grid electrodes for periprostatic cavernous nerve mapping during radical prostatectomy. We conducted an engineering design process for evaluation and prototyping an electrode-containing grid, followed by testing its feasibility in a simulated radical prostatectomy cadaveric workshop and its usability in a clinical investigation of men with localized prostate cancer undergoing radical prostatectomy. We demonstrated that electrode-containing grids can be used during radical prostatectomy and would meet requirements for localizing and recording nerve signals in the periprostatic region during radical prostatectomy that are functionally relevant for penile erection and urinary continence functions. These findings suggest the potential utility of adjunct technologies to improve functional outcomes after radical prostatectomy as well as potentially other pelvic surgeries in which iatrogenic nerve injury is known to occur. The primary strength of this study is its methodical approach for developing and testing electrode-containing grids as an electrophysiological nerve testing and recording tool for periprostatic cavernous nerve mapping. Limitations relate to indeterminate real-time functional measures of nerve signaling activity during surgical perturbations. Our study suggests that electrode-containing grids may be applied in an intraoperative neuromonitoring platform for radical prostatectomy, serving as a tool for periprostatic cavernous nerve mapping. Applying this technology during radical prostatectomy may facilitate nerve localization and preservation objectives intraoperatively, thereby translating into improvements in functional outcomes after this surgery.