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Wei S, Hu Q, Ma J, Dai X, Sun Y, Han G, Meng H, Xu W, Zhang L, Ma X, Peng J, Wang Y. Acellular nerve xenografts based on supercritical extraction technology for repairing long-distance sciatic nerve defects in rats. Bioact Mater 2022; 18:300-320. [PMID: 35387172 PMCID: PMC8961471 DOI: 10.1016/j.bioactmat.2022.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Abstract
Compared to conventional artificial nerve guide conduits (NGCs) prepared using natural polymers or synthetic polymers, acellular nerve grafts (ACNGs) derived from natural nerves with eliminated immune components have natural bionic advantages in composition and structure that polymer materials do not have. To further optimize the repair effect of ACNGs, in this study, we used a composite technology based on supercritical carbon dioxide (scCO2) extraction to process the peripheral nerve of a large mammal, the Yorkshire pig, and obtained an innovative Acellular nerve xenografts (ANXs, namely, CD + scCO2 NG). After scCO2 extraction, the fat and DNA content in CD + scCO2 NG has been removed to the greatest extent, which can better supported cell adhesion and proliferation, inducing an extremely weak inflammatory response. Interestingly, the protein in the CD + scCO2 NG was primarily involved in signaling pathways related to axon guidance. Moreover, compared with the pure chemical decellularized nerve graft (CD NG), the DRG axons grew naturally on the CD + scCO2 NG membrane and extended long distances. In vivo studies further revealed that the regenerated nerve axons had basically crossed the CD + scCO2 NG 3 weeks after surgery. 12 weeks after surgery, CD + scCO2 NG was similar to autologous nerves in improving the quality of nerve regeneration, target muscle morphology and motor function recovery and was significantly better than hollow NGCs and CD NG. Therefore, we believe that the fully decellularized and fat-free porcine ACNGs may be the most promising “bridge” for repairing human nerve defects at this stage and for some time to come. The native adipose tissue inside acellular nerve xenografts hinders regenerated nerve fibers. Environmentally friendly scCO2 extraction has natural advantages in reducing fat content. Natural three-dimensional nerve basement membrane tube structure guides regenerating axons.
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Asker H, Yilmaz-Oral D, Oztekin CV, Gur S. An update on the current status and future prospects of erectile dysfunction following radical prostatectomy. Prostate 2022; 82:1135-1161. [PMID: 35579053 DOI: 10.1002/pros.24366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies. OBJECTIVE This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research. METHOD Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database. RESULTS Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies. CONCLUSION This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.
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Affiliation(s)
- Heba Asker
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
- Department of Medical Pharmacology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
- Graduate School of Health Sciences, Ankara University, Ankara, Turkey
| | - Didem Yilmaz-Oral
- Department of Pharmacology, Faculty of Pharmacy, Cukurova University, Adana, Turkey
| | - Cetin Volkan Oztekin
- Department of Urology, Faculty of Medicine, University of Kyrenia, Girne, Turkey
| | - Serap Gur
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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Baker L, Tar M, Kramer AH, Villegas GA, Charafeddine RA, Vafaeva O, Nacharaju P, Friedman J, Davies KP, Sharp DJ. Fidgetin-like 2 negatively regulates axonal growth and can be targeted to promote functional nerve regeneration. JCI Insight 2021; 6:138484. [PMID: 33872220 PMCID: PMC8262307 DOI: 10.1172/jci.insight.138484] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
The microtubule (MT) cytoskeleton plays a critical role in axon growth and guidance. Here, we identify the MT-severing enzyme fidgetin-like 2 (FL2) as a negative regulator of axon regeneration and a therapeutic target for promoting nerve regeneration after injury. Genetic knockout of FL2 in cultured adult dorsal root ganglion neurons resulted in longer axons and attenuated growth cone retraction in response to inhibitory molecules. Given the axonal growth-promoting effects of FL2 depletion in vitro, we tested whether FL2 could be targeted to promote regeneration in a rodent model of cavernous nerve (CN) injury. The CNs are parasympathetic nerves that regulate blood flow to the penis, which are commonly damaged during radical prostatectomy (RP), resulting in erectile dysfunction (ED). Application of FL2-siRNA after CN injury significantly enhanced functional nerve recovery. Remarkably, following bilateral nerve transection, visible and functional nerve regeneration was observed in 7 out of 8 animals treated with FL2-siRNA, while no control-treated animals exhibited regeneration. These studies identify FL2 as a promising therapeutic target for enhancing regeneration after peripheral nerve injury and for mitigating neurogenic ED after RP - a condition for which, at present, only poor treatment options exist.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - David J. Sharp
- Department of Physiology and Biophysics
- Dominick P. Purpura Department of Neuroscience, and
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
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Sun X, Wang Y, Guo Z, Xiao B, Sun Z, Yin H, Meng H, Sui X, Zhao Q, Guo Q, Wang A, Xu W, Liu S, Li Y, Lu S, Peng J. Acellular Cauda Equina Allograft as Main Material Combined with Biodegradable Chitin Conduit for Regeneration of Long-Distance Sciatic Nerve Defect in Rats. Adv Healthc Mater 2018; 7:e1800276. [PMID: 30044554 DOI: 10.1002/adhm.201800276] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/18/2018] [Indexed: 11/10/2022]
Abstract
Autologous nerve grafting (ANG), the gold standard treatment for peripheral nerve defects, still has many restrictions. In this study, the acellular cauda equina allograft (ACEA), which consists of biodegradable chitin conduit and acellular cauda equina, is developed. The cauda equina is able to complete decellularization more quickly and efficiently than sciatic nerves under the same conditions, and it is able to reserve more basal lamina tube. In vitro, ACEA shows superior guidance capacity for the regeneration of axons and migration of Schwann cells compared to acellular sciatic nerve allograft (ASNA) in dorsal root ganglion culture. In vivo, ACEA is used to bridge 15 mm long-distance defects in rat sciatic nerves. On day 21 after transplantation, the regenerative distance of neurofilaments in the grafting segment is not significantly different between the ACEA and ANG groups. At week 12, ACEA group shows better sciatic nerve repair than chitin conduit only and ASNA groups, and the effect is similar to that in the ANG group as determined by gait analysis, neural electrophysiological, and histological analyses. The above results suggest that the ACEA has the potential to become a new biological material as a replacement for autografting in the treatment of long-distance nerve defects.
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Affiliation(s)
- Xun Sun
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- School of Medicine; Nankai University; No. 94 Weijin Road Tianjin 300071 P. R. China
| | - Yu Wang
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| | - Zhiyuan Guo
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Bo Xiao
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Zhen Sun
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Heyong Yin
- Department of Surgery; Ludwig-Maximilians-University (LMU); Nussbaumstr. 20 Munich 80336 Germany
| | - Haoye Meng
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Xiang Sui
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Qing Zhao
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| | - Quanyi Guo
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Aiyuan Wang
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Wenjing Xu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Shuyun Liu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Yaojun Li
- Department of Otolaryngology; First Teaching Hospital of Tianjin University of Traditional Chinese Medicine; No. 314 An Shan Xi Road Tianjin 300192 P. R. China
| | - Shibi Lu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Jiang Peng
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
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Mahmood J, Shamah AA, Creed TM, Pavlovic R, Matsui H, Kimura M, Molitoris J, Shukla H, Jackson I, Vujaskovic Z. Radiation-induced erectile dysfunction: Recent advances and future directions. Adv Radiat Oncol 2016; 1:161-169. [PMID: 28740886 PMCID: PMC5514009 DOI: 10.1016/j.adro.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer is one of the most prevalent cancers and the second leading cause of cancer-related deaths in men in the United States. A large number of patients undergo radiation therapy (RT) as a standard care of treatment; however, RT causes erectile dysfunction (radiation-induced erectile dysfunction; RiED) because of late side effects after RT that significantly affects quality of life of prostate cancer patients. Within 5 years of RT, approximately 50% of patients could develop RiED. Based on the past and current research findings and number of publications from our group, the precise mechanism of RiED is under exploration in detail. Recent investigations have shown prostate RT induces significant morphologic arterial damage with aberrant alterations in internal pudendal arterial tone. Prostatic RT also reduces motor function in the cavernous nerve which may attribute to axonal degeneration may contributing to RiED. Furthermore, the advances in radiogenomics such as radiation induced somatic mutation identification, copy number variation and genome-wide association studies has significantly facilitated identification of biomarkers that could be used to monitoring radiation-induced late toxicity and damage to the nerves; thus, genomic- and proteomic-based biomarkers could greatly improve treatment and minimize arterial tissue and nerve damage. Further, advanced technologies such as proton beam therapy that precisely target tumor and significantly reduce off-target damage to vital organs and healthy tissues. In this review, we summarize recent advances in RiED research and novel treatment modalities for RiED. We also discuss the possible molecular mechanism involved in the development of RiED in prostate cancer patients. Further, we discuss various readily available methods as well as novel strategies such as stem cell therapies, shockwave therapy, nerve grafting with tissue engineering, and nutritional supplementations might be used to mitigate or cure sexual dysfunction following radiation treatment.
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Affiliation(s)
- Javed Mahmood
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Aksinija A Shamah
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - T Michael Creed
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Radmila Pavlovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hotaka Matsui
- The James Buchanan Brady Urological Institute, and Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaki Kimura
- Department of Urology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Jason Molitoris
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hem Shukla
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Isabel Jackson
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Zeljko Vujaskovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
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Luo H, Zhu B, Zhang Y, Jin Y. Tissue-engineered nerve constructs under a microgravity system for peripheral nerve regeneration. Tissue Eng Part A 2014; 21:267-76. [PMID: 25088840 DOI: 10.1089/ten.tea.2013.0565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Mesenchymal stem cells (MSCs) seeded in a 3D scaffold often present characteristics of low proliferation and migration, which affect the microstructure of tissue-engineered nerves (TENs) and impair the therapeutic effects of nerve defects. By promoting MSC differentiation and mass/nutrient transport, rotary cell culture systems (RCCSs) display potential for advancing the construction of MSC-based TENs. Thus, in this study, we attempted to construct a TEN composed of adipose-derived mesenchymal stem cells (ADSCs) and acellular nerve graft (ANG) utilizing an RCCS. Compared to TENs prepared in a static 3D approach, MTT and cell count results displayed an increased number of ADSCs for TENs in an RCCS. The similarity in cell cycle states and high rates of apoptosis in the static 3D culture demonstrated that the higher proliferation in the RCCS was not due to microgravity regulation but a result of preferential mass/nutrient transport. Quantitative PCR and ELISA indicated that the RCCS promoted the expression of ADSC neural differentiation-associated genes compared to the static 3D culture. Furthermore, this difference was eliminated by adding the Notch1 signaling pathway inhibitor DAPT to the 3D static culture. TEM, axon immunostaining, and retrograde labeling analysis after sciatic nerve transplantation indicated that the TENs prepared in the RCCS exhibited more regenerative characteristics for repairing peripheral nerves than those prepared in a static 3D approach. Therefore, these findings suggest that the RCCS can modulate the construction, morphology, and function of engineered nerves as a promising alternative for nerve regeneration.
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Affiliation(s)
- Hailang Luo
- 1 Research and Development Center for Tissue Engineering, Fourth Military Medical University , Xi'an, China
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7
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Kuffler DP. An assessment of current techniques for inducing axon regeneration and neurological recovery following peripheral nerve trauma. Prog Neurobiol 2014; 116:1-12. [DOI: 10.1016/j.pneurobio.2013.12.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 12/11/2013] [Accepted: 12/17/2013] [Indexed: 12/20/2022]
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8
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Erectile Function Restoration After Repair of Resected Cavernous Nerves by Adipose-Derived Stem Cells Combined with Autologous Vein Graft in Rats. Cell Mol Neurobiol 2014; 34:393-402. [DOI: 10.1007/s10571-013-0024-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/26/2013] [Indexed: 12/15/2022]
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9
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Kang SB, Ju YM, Lee SJ, Atala A, Yoo JJ. Functional recovery of denervated muscle by neurotization using nerve guidance channels. J Tissue Eng Regen Med 2013; 9:838-46. [DOI: 10.1002/term.1696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/29/2012] [Accepted: 12/20/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Sung-Bum Kang
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
- Department of Surgery, Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seongnam South Korea
| | - Young Min Ju
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - James J. Yoo
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
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Bond CW, Angeloni N, Harrington D, Stupp S, Podlasek CA. Sonic Hedgehog regulates brain-derived neurotrophic factor in normal and regenerating cavernous nerves. J Sex Med 2012; 10:730-7. [PMID: 23237228 DOI: 10.1111/jsm.12030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The cavernous nerve (CN) is commonly injured during prostatectomy. Manipulation of the nerve microenvironment is critical to improve regeneration and develop novel erectile dysfunction therapies. Sonic hedgehog (SHH) treatment promotes CN regeneration. The mechanism of how this occurs is unknown. Brain-derived neurotrophic factor (BDNF) facilitates return of erectile function after CN injury and it has been suggested in cortical neurons and the sciatic nerve that BDNF may be a target of SHH. AIM To determine if SHH promotes CN regeneration through a BDNF-dependent mechanism. METHODS Sprague Dawley rats underwent (i) bilateral CN crush (N = 15); (ii) SHH treatment of pelvic ganglia (PG)/CN (N = 10); (iii) SHH inhibition in PG/CN (N = 14 rats); (iv) CN crush with SHH treatment of PG/CN (N = 10 rats); (v) CN crush with SHH treatment and BDNF inhibition (N = 14 rats); and (vi) CN injury and SHH treatment of the penis (N = 23). MAIN OUTCOME MEASURES BDNF and glial fibrillary acidic protein were quantified in PG/CN by Western, and a t-test was used to determine differences. RESULTS In normal rats SHH inhibition in the PG/CN decreased BDNF 34% and SHH treatment increased BDNF 36%. BDNF was increased 44% in response to SHH treatment of crushed CNs, and inhibition of BDNF in crushed CNs treated with SHH protein hampers regeneration. CONCLUSIONS SHH regulates BDNF in the normal and regenerating PG/CN. BDNF is part of the mechanism of how SHH promotes regeneration, thus providing an opportunity to further manipulate the nerve microenvironment with combination therapy to enhance regeneration.
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Affiliation(s)
- Christopher W Bond
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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11
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Chung E, Brock GB. Emerging and Novel Therapeutic Approaches in the Treatment of Male Erectile Dysfunction. Curr Urol Rep 2011; 12:432-43. [DOI: 10.1007/s11934-011-0216-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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12
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Hisasue SI. Advances in the study of the peripheral nervous system for erection in animals and humans. Reprod Med Biol 2011; 10:121-129. [PMID: 29699088 DOI: 10.1007/s12522-011-0081-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 03/19/2011] [Indexed: 11/27/2022] Open
Abstract
Introduction Since Walsh first emphasized the importance of preserving the neurovascular bundle n to protect the cavernous nerve during pelvic surgery, patients' sexual life quality has dramatically improved. Today, nerve-sparing radical prostatectomy is the established gold standard for organ-confined prostate cancer patients. Recent technical advances in functional assessment such as intraoperative electrical stimulation have unveiled new anatomical features and physiological roles. Basic research has advanced understanding of cavernous nerve function, while molecular biology has uncovered the crucial role of neuronal nitric oxide in mediating erection, and has led to new treatments such as phosphodiesterase type-5 inhibitors. A recent focus in cavernous nerve research concerns the nerve distribution external to the neurovascular bundle. The cavernous nerves in humans appear to be distributed more widely beneath the lateral pelvic fascia than in other animals, and electrical stimulation studies suggest possible involvement of these nerves in erection. These findings have prompted new surgical techniques such as the "veil of Aphrodite", or "intrafascial nerve-sparing" procedures. Materials and Methods These recent anatomical and physiological studies in humans and animals and their impact are reviewed in this article. Conclusions Further investigation should stimulate future advances in strategies to preserve erectile function in RP patients.
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Affiliation(s)
- Shin-Ichi Hisasue
- Department of Urology, School of Medicine Sapporo Medical University S1-W16, Chuo-ku 060-8543 Sapporo Hokkaido Japan
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Feil G, Daum L, Amend B, Maurer S, Renninger M, Vaegler M, Seibold J, Stenzl A, Sievert KD. From tissue engineering to regenerative medicine in urology--the potential and the pitfalls. Adv Drug Deliv Rev 2011; 63:375-8. [PMID: 21167237 DOI: 10.1016/j.addr.2010.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/01/2010] [Accepted: 12/07/2010] [Indexed: 01/18/2023]
Abstract
Tissue engineering is a promising technique for the development of biological substitutes that can restore, maintain, or improve tissue function. The creation of human tissue-engineered products, generated of autologous somatic cells or adult stem cells with or without seeding of biocompatible matrices is a vision to resolve the lack of tissues and organs for transplantation and to offer new options for reconstructive surgery. Tissue engineering in urology aims at the reconstruction of the urinary tract by creating anatomically and functionally equal tissue. It is a rapidly evolving field in basic research and the transfer into the clinic has yet to be realized. Necessary steps from bench to bed are the proof of principle in animal models and the proof of concept in clinical trials following good manufacturing practice and ethical and legal requirements for human tissue-engineered products. Up to now, obstacles still occur in the neovascularization of implants and ingrowth of nerves in vivo. Moreover the harvesting of mesenchymal stem cells out of bone marrow as well as the explant of urothelial cells yet demands rather invasive surgery to achieve a successful outcome. Thus, other cell sources and harvesting techniques like placenta and adipose tissue for mesenchymal stem cells and bladder irrigation for urothelial cells require closer investigation.
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Lin G, Albersen M, Harraz AM, Fandel TM, Garcia M, McGrath MH, Konety BR, Lue TF, Lin CS. Cavernous nerve repair with allogenic adipose matrix and autologous adipose-derived stem cells. Urology 2011; 77:1509.e1-8. [PMID: 21492917 DOI: 10.1016/j.urology.2010.12.076] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/15/2010] [Accepted: 12/22/2010] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate whether adipose-derived matrix seeded with adipose-derived stem cells (ADSC) can facilitate the repair of injured cavernous nerves (CNs). METHODS Human and rat adipose tissues were decellularized and fabricated into various forms, including adipose tissue-derived acellular matrix thread (ADMT). ADMT seeded with ADSC were transplanted into subcutaneous space and examined for signs of inflammation. ADSC-seeded ADMTs were then used to repair CN injury in rats, followed by assessment of histology and erectile function. RESULTS Adipose tissue can be fabricated into acellular matrices of various shapes and sizes, including threads and sheets. Seeding of ADMT occurred rapidly: within 24 hours, 55% of the surface was covered with ADSC and within 1 week, 90% was covered. Transplantation of the seeded ADMT into the subcutaneous space of an allogenic host showed no signs of inflammatory reaction. At 3 months after grafting into CN injury rats, approximately twice as many cells were found on seeded ADMT as on unseeded ADMT. The seeded ADMT also had various degrees of S100 and neuronal nitric oxide synthase expression, suggesting CN axonal ingrowth. Rats grafted with seeded ADMT overall had the best erectile function recovery when compared with those grafted with unseeded ADMT and those ungrafted. However, as a result of large variations, the differences did not reach statistic significance (P = .07). CONCLUSIONS Grafting of ADSC-seeded matrix resulted in a substantial recovery of erectile function and improvement of histology. However, further refinement of the matrix architecture is needed to improve the success rate.
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Affiliation(s)
- Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, University of California, San Francisco, CA 94143-0738, USA
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Burnett AL, Goldstein I, Andersson KE, Argiolas A, Christ G, Park K, Xin ZC. Future sexual medicine physiological treatment targets. J Sex Med 2011; 7:3269-304. [PMID: 21029380 DOI: 10.1111/j.1743-6109.2010.02025.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Sexual function in men and women incorporates physiologic processes and regulation of the central and peripheral nervous systems, the vascular system, and the endocrine system. There is need for state-of-the-art information as there is an evolving research understanding of the underlying molecular biological factors and mechanisms governing sexual physiologic functions. AIM To develop an evidence-based, state-of-the-art consensus report on the current knowledge of the major cellular and molecular targets of biologic systems responsible for sexual physiologic function. METHODS State-of-the-art knowledge representing the opinions of seven experts from four countries was developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURES Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS Scientific investigation in this field is needed to increase knowledge and foster development of the future line of treatments for all forms of biological-based sexual dysfunction. This article addresses the current knowledge of the major cellular and molecular targets of biological systems responsible for sexual physiologic function. Future treatment targets include growth factor therapy, gene therapy, stem and cell-based therapies, and regenerative medicine. CONCLUSIONS Scientific discovery is critically important for developing new and increasingly effective treatments in sexual medicine. Broad physiologic directions should be vigorously explored and considered for future management of sexual disorders.
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Affiliation(s)
- Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
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16
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Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy. Curr Opin Urol 2011; 21:49-59. [DOI: 10.1097/mou.0b013e32834120e9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Yang LM, Liu XL, Zhu QT, Zhang Y, Xi TF, Hu J, He CF, Jiang L. Human peripheral nerve-derived scaffold for tissue-engineered nerve grafts: Histology and biocompatibility analysis. J Biomed Mater Res B Appl Biomater 2010; 96:25-33. [DOI: 10.1002/jbm.b.31719] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Shokeir AA, Harraz AM, El-Din ABS. Tissue engineering and stem cells: basic principles and applications in urology. Int J Urol 2010; 17:964-73. [PMID: 20969644 DOI: 10.1111/j.1442-2042.2010.02643.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To overcome problems of damaged urinary tract tissues and complications of current procedures, tissue engineering (TE) techniques and stem cell (SC) research have achieved great progress. Although diversity of techniques is used, urologists should know the basics. We carried out a literature review regarding the basic principles and applications of TE and SC technologies in the genitourinary tract. We carried out MEDLINE/PubMed searches for English articles until March 2010 using a combination of the following keywords: bladder, erectile dysfunction, kidney, prostate, Peyronie's disease, stem cells, stress urinary incontinence, testis, tissue engineering, ureter, urethra and urinary tract. Retrieved abstracts were checked, and full versions of relevant articles were obtained. Scientists have achieved great advances in basic science research. This is obvious by the tremendous increase in the number of publications. We divided this review in two topics; the first discusses basic science principles of TE and SC, whereas the second part delineates current clinical applications and advances in urological literature. TE and SC applications represent an alternative resource for treating complicated urological diseases. Despite the paucity of clinical trials, the promising results of animal models and continuous work represents the hope of treating various urological disorders with this technology.
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Affiliation(s)
- Ahmed A Shokeir
- Mansoura Urology and Nephrology Center, Urology Department, Mansoura, Egypt.
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Angeloni NL, Bond CW, Tang Y, Harrington DA, Zhang S, Stupp SI, McKenna KE, Podlasek CA. Regeneration of the cavernous nerve by Sonic hedgehog using aligned peptide amphiphile nanofibers. Biomaterials 2010; 32:1091-101. [PMID: 20971506 DOI: 10.1016/j.biomaterials.2010.10.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/01/2010] [Indexed: 02/07/2023]
Abstract
SHH plays a significant role in peripheral nerve regeneration and has clinical potential to be used as a regenerative therapy for the CN in prostatectomy patients and in other patients with neuropathy of peripheral nerves. Efforts to regenerate the cavernous nerve (CN), which provides innervation to the penis, have been minimally successful, with little translation into improved clinical outcomes. We propose that, Sonic hedgehog (SHH), is critical to maintain CN integrity, and that SHH delivered to the CN by novel peptide amphiphile (PA) nanofibers, will promote CN regeneration, restore physiological function, and prevent penile morphology changes that result in erectile dysfunction (ED). We performed localization studies, inhibition of SHH signaling in the CN, and treatment of crushed CNs with SHH protein via linear PA gels, which are an innovative extended release method of delivery. Morphological, functional and molecular analysis revealed that SHH protein is essential to maintain CN architecture, and that SHH treatment promoted CN regeneration, suppressed penile apoptosis and caused a 58% improvement in erectile function in less than half the time reported in the literature. These studies show that SHH has substantial clinical application to regenerate the CN in prostatectomy and diabetic patients, that this methodology has broad application to regenerate any peripheral nerve that SHH is necessary for maintenance of its structure, and that this nanotechnology method of protein delivery may have wide spread application as an in vivo delivery tool in many organs.
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Affiliation(s)
- Nicholas L Angeloni
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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Zhang Y, Luo H, Zhang Z, Lu Y, Huang X, Yang L, Xu J, Yang W, Fan X, Du B, Gao P, Hu G, Jin Y. A nerve graft constructed with xenogeneic acellular nerve matrix and autologous adipose-derived mesenchymal stem cells. Biomaterials 2010; 31:5312-24. [PMID: 20381139 DOI: 10.1016/j.biomaterials.2010.03.029] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/10/2010] [Indexed: 12/25/2022]
Abstract
Since synthetic nerve conduits do not exhibit the characteristics of regeneration, they are generally inadequate substitutes for autologous nerve graft in the repair of long peripheral nerve defects. To resolve this problem, in this study, we constructed a nerve regeneration characteristics-containing nerve graft through integrating xenogeneic acellular nerve matrix (ANM) with autologous neural differentiated adipose-derived mesenchymal stem cells (ADSCs). Xenogeneic ANM was processed by a protocol removing cells and myelin sheath completely, meanwhile preserving growth factors and extracellular matrix (ECM) microstructure of natural nerve, such as porous and basal lamina tube. Cytocompatibility and immunocompatibility evaluation revealed that ANM could support cell attachment and proliferation, and did not stimulate vigorous host reject response. After inoculation of neural differentiated ADSCs onto ANM, differentiated cells were observed to align along longitudinal axis of ANM, resembling band of büngner, and persistently express NGF, GDNF, and BDNF. In vivo, neural differentiated ADSCs also presented glial cell characteristics and promote nerve regeneration 7 days post transplantation. We repaired 1cm Sprague Dawley rat sciatic nerve defects using this nerve graft construction and nerve gap regeneration was indicated by electrophysiology, retrograde labeling and histology analysis. Therefore, we conclude that constructed nerve graft, offering nerve regeneration characteristics, hold great promise to replace autologous in repair peripheral nerve defect.
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Affiliation(s)
- Yongjie Zhang
- Department of Oral Histology and Pathology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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Abstract
Bridging nerve gaps with suitable grafts is a major clinical problem. The autologous nerve graft is considered to be the gold standard, providing the best functional results; however, donor site morbidity is still a major disadvantage. Various attempts have been made to overcome the problems of autologous nerve grafts with artificial nerve tubes, which are “ready-to-use” in almost every situation. A wide range of materials have been used in animal models but only few have been applied to date clinically, where biocompatibility is an inevitable prerequisite. This review gives an idea about artificial nerve tubes with special focus on their biocompatibility in animals and humans.
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Affiliation(s)
- Felix Stang
- Department of Plastic, Reconstructive and Hand Surgery, University of Luebeck, 23538 Luebeck, Germany
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-451-5002061; Fax: +49-451-5002190
| | - Gerburg Keilhoff
- Institute of Biochemistry and Cell Biology, University of Magdeburg, 39120 Magdeburg, Germany; E-Mail:
| | - Hisham Fansa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Klinikum Bielefeld-Mitte, 33604 Bielefeld, Germany; E-Mail:
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Anatomical description of the periprostatic nerves in the male rhesus monkey (Macaca mulatta). World J Urol 2009; 29:375-80. [PMID: 19760222 DOI: 10.1007/s00345-009-0473-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/27/2009] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Recent publications have revealed a variable course of the periprostatic nerves in humans. It is unclear to what extent nerves outside the dorsolateral region of the prostate are involved in the physiology of erectile function. As functional studies in humans are limited by ethical aspects investigations in animal models could provide further insight. The intention of this study was to give a detailed description of the topographical anatomy of autonomic nerves along the seminal vesicles and the prostate in male rhesus monkeys (Macaca mulatta) to investigate its suitability as an animal model for future physiological studies. METHODS Wholemount serial sections of pelvic organ blocks of ten male rhesus monkeys were investigated. Autonomic nerves were stained with an antibody against S100. RESULTS Autonomic nerves were dispersed along the dorsolateral to the ventrolateral aspect of the capsule of the prostate within a layer of connective tissue. There was no accumulation of vessels and nerves in the dorsolateral position of the prostate. The prostate is located dorsally to the urethra and does not encircle it. No adjacent nerves were found in the cranial two-thirds of the seminal vesicles. CONCLUSIONS The male rhesus monkey is limited suitable as an animal model for studies on the periprostatic nerves provided the following differences to humans are considered: the special topography of the prostate, the nerve course along the seminal vesicles and the missing nerve accumulation dorsolaterally to the prostate.
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Muir D. The potentiation of peripheral nerve sheaths in regeneration and repair. Exp Neurol 2009; 223:102-11. [PMID: 19505459 DOI: 10.1016/j.expneurol.2009.05.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 01/09/2023]
Abstract
Traumatic injury to the nervous system often results in life changing loss of neurological function. Spontaneous neural regeneration occurs rarely and the outcome of therapeutic intervention is most often unacceptable. An intensive effort is underway to improve methods and technologies for nervous system repair. To date, the most success has been attained in the outcomes of peripheral nerve restoration. The importance of the peripheral nerve sheaths in successful nerve regeneration has been long recognized. In particular, Schwann cells and their basal laminae play a central role in axon development, maintenance, physiology, and response to injury. The endoneurial basal lamina is rich in components that promote axonal growth. It is now evident that the bioactivities of these components are counterbalanced by various factors that impede axonal growth. The growth-promoting potential of peripheral nerve is realized in the degenerative processes that occur distal to a lesion. This potentiation involves precise spatiotemporal alterations in the balance of antagonistic regulators of axonal growth. Experimental alteration of nerve sheath composition can also potentiate nerve and improve key features of nerve regeneration. For instance, enzymatic degradation of inhibitory chondroitin sulfate proteoglycan mimics endogenous processes that potentiate degenerated nerve and improves the outcome of direct nerve repair and grafting in animal models. This review provides a perspective of the essential role that peripheral nerve sheaths play in regulating axonal regeneration and focuses on discoveries leading to the inception and development of novel therapies for nerve repair.
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Affiliation(s)
- David Muir
- Department of Pediatrics, Neurology Division, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, Florida, USA.
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White WM, Kim ED. Interposition nerve grafting during radical prostatectomy: cumulative review and critical appraisal of literature. Urology 2009; 74:245-50. [PMID: 19428071 DOI: 10.1016/j.urology.2008.12.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/15/2008] [Accepted: 12/20/2008] [Indexed: 11/25/2022]
Abstract
In 1997, the first report of sural nerve interposition grafting during radical prostatectomy was published in Urology. The favorable findings in this initial pilot study generated numerous follow-up reports that have demonstrated conflicting and contradictory outcomes. Certainly, controversy exists regarding the true benefit of nerve grafting. This review will objectively and critically summarize the salient literature, discuss evolving techniques, and offer insight into the future of interposition grafting in the current era of clinically localized prostate cancer and robotic prostatectomy.
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Affiliation(s)
- Wesley M White
- Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio 44195, USA.
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Riesz P, Rusz A, Szucs M, Majoros A, Nyírády P, Keszthelyi A, Szucs M, Mavrogenis S, Filkor G, Pánovics J, Romics I. [Prevention and treatment of erectile dysfunction after radical prostatectomy]. Orv Hetil 2009; 150:831-7. [PMID: 19383574 DOI: 10.1556/oh.2009.28569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.
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Affiliation(s)
- Péter Riesz
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Urológiai Klinika, Budapest Ulloi út 78/B, 1082.
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