Nerve Stimulation May Help Preserve Erectile Function after Radical Prostatectomy

arthur burnett
Arthur Burnett, right, with Urology fellow
Robert Segal: Because the nerves lack
protective insulation, they are vulnerable
to injury during surgery..

As its name suggests, the nerve-sparing radical prostatectomy is designed to preserve, as much as possible, the bundles of nerves on either side of the prostate that are responsible for erection. If cancer is not nearby and these nerves can be spared, a careful surgeon takes extreme care to treat them gently. However, these nerves do not have the protective coating (the myelin sheath) that insulates larger nerves, and this makes them vulnerable to injury from heat and stretching. For this reason, says neuro-urologist Arthur Burnett, M.D., M.B.A., and The Patrick C. Walsh Professor of Urology, these nerves often take a hit simply because neighboring tissue is being removed – imagine windows shattering throughout a city block after a grenade goes off in a parked car. "It is evident that these nerves still sustain a ‘shock effect’ during surgery despite our best precautions," he says. "The result is that erection recovery after surgery is often delayed."

Burnett’s laboratory, which has made many important discoveries in the physiology of erection and in developing strategies to give extra protection to these nerves, has been working to "consider how the nerves can be induced to make a more rapid functional recovery," he explains.

Is it possible that these nerves could somehow be jump-started – stimulated somehow, to encourage regeneration? In preclinical studies, Burnett and colleagues have investigated using a chronic implantable nerve stimulation system; more recently, they have focused on an approach that does not require implantation, which works externally to stimulate nerves to produce an erection. This research was recently published in the Journal of Sexual Medicine.

"The investigative work has led to the development of an external vibration stimulatory device that may be applied under a specified protocol after surgery," Burnett says. "Our preliminary results suggest a likely benefit of this treatment. A definitive clinical trial is currently under way."

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