Burnett and Bivalacqua: Protecting the fragile network of blood vessels.Neuro-urologist Arthur L. Burnett knows, as a surgeon, that when he removes a cancerous prostate, he will inevitably place the extremely delicate nerves on either side of it at risk — even though he uses the “nervesparing” procedures pioneered by Patrick C. Walsh, M.D. For years, in laboratory and clinical studies, Burnett, M.D., M.B.A., the Patrick C. Walsh Distinguished Professor of Urology, has sought to blunt the shock of surgery. He has investigated neuroprotective agents that could act as therapeutic armor — shielding, strengthening, and even restoring these tiny nerves that are responsible for erection. Now, he is extending his scope of neuroprotection to the fragile network of blood vessels and chambers within the penis. Even though they’re not directly traumatized by surgery, “these structures may degenerate or shrivel,” he says, “and thus contribute to poor recovery of erectile function in some men after surgery.”
Several years ago, investigators found that some drugs, designed to treat high blood pressure, also help make blood vessels stronger. Intrigued by these results, Burnett and colleagues began studying such agents (specifically, they’re called “angiotensin II type 1 receptor antagonists”) in rats with nerve injuries similar to those found in men after radical prostatectomy. They found that one of these drugs, called Irbesartan, not only speeds up the recovery of erections after surgery, but limits tissue scarring and nerve damage to the penis. The results have been so promising that Burnett began giving Irbesartan after surgery to his radical prostatectomy patients. “In preliminary results, we have observed measurably improved benefits in penile health and erection recovery,” he says. He plans to begin a formal investigation of this nervestrengthening therapy soon.