Journal of Andrology
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Published-Ahead-of-Print February 5, 2009, DOI:10.2164/jandrol.108.006866
Journal of Andrology, Vol. 30, No. 4, July/August 2009
Copyright © American Society of Andrology
DOI: 10.2164/jandrol.108.006866

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Review

Exploring the Potential Role of Neuromodulatory Drugs in Radical Prostatectomy Patients

JOHN P. MULHALL

From the Sexual & Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.

Correspondence to: Dr John P. Mulhall, Department of Surgery, Urology Service, 525 E 68th St, New York, NY 10021 (e-mail: mulhalj1{at}mskcc.org).



Abstract

Since the introduction of the nerve-sparing radical prostatectomy (RP), potency preservation rates of between 20% and 90% have been reported. It is irrefutable that the nerve-sparing status of an RP is predictive of recovery of erectile function. Bilateral nerve sparing is associated with superior spontaneous and oral therapy–assisted recovery of erectile function compared to unilateral nerve sparing, which in turn is more likely to lead to functional erections than non–nerve-sparing surgery. Neural regeneration is the mechanism by which erectile function improves over time following RP. Although the degree of neural trauma that occurs intraoperatively is a determinant of long-term recovery of neural function, biological factors involved in neural regeneration are likely important determinants of the completeness of neural recovery. Furthermore, these biological factors are likely a major reason for the interindividual variation in recovery of erectile function after this operation. Recently, the development of rat models of cavernous nerve injury has facilitated the study of neuroprotective and neuroregenerative agents. This paper reviews the current knowledge on pharmacological neuromodulation as it pertains to the radical pelvic surgery patient. The animal evidence is highly supportive of such agents' having a positive impact on erectile function recovery after RP. Human trial data are awaited.

     Key words: Cavernous nerve, neuropraxia, immunophilin ligand, neuromodulation, erectile function






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