Journal of Andrology
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Published-Ahead-of-Print February 5, 2009, DOI:10.2164/jandrol.108.006866

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Exploring the Potential Role of Neuromodulatory Drugs in the Radical Prostatectomy Patient

John P. Mulhall *

* To whom correspondence should be addressed. E-mail: mulhalj1{at}mskcc.org.

Since the introduction of the nerve sparing radical prostatectomy, potency preservation rates of between 20-90% have been reported. It is irrefutable that the nerve-sparing status of a 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. While the degree of neural trauma that occurs intra-operatively 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 inter-individual 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 neuro-regenerative 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 radical prostatectomy. Human trial data are awaited.


Key words: Erectile Dysfunction • neuromodulation • radical pelvic surgery






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