Penile Weight and Cell Subtype Specific Changes in a Post-Radical Prostatectomy Model of Erectile Dysfunction

Abstract

These data suggest the importance of neural integrity to maintain penile homeostasis. The loss in penile weight was consistent with the anecdotal experience of many clinicians. Decreased DNA content may have been due to significant levels of apoptosis in smooth muscle cells. Preserved protein content may suggest an increase in extracellular protein, as postulated in corporeal fibrosis. The subtunical population of apoptotic smooth muscle cells revealed a mechanism for veno-occlusive dysfunction observed after radical prostatectomy. These effects were significantly moderated in the unilateral model, reinforcing the critical nature of neural integrity.

Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy

“…Similarly to other studies, they concluded that progressive fibrosis in the corpora cavernosa after radical prostatectomy resulted from denervation and/or an ischemic process (19). Several human and animal studies support the hypothesis of maintaining adequate penile oxygenation by preserving neurovascular bundles and thus erectile function, may play an important role in preventing irreversible penile fibrotic changes (8,14,15). User et al performed a study on postpubertal rats and grouped them according to bilateral or unilateral cavernous nerve transection versus a sham operation (14).…”

“…Potential pathophysiology of ED that may occur after RP has been widely discussed in several studies (13)(14)(15) and there are studies evaluating the penile length changes after RP (7,12,16). The mechanism responsible for the reduction in penile length after RP has not been elucidated.…”

“…Several human and animal studies support the hypothesis of maintaining adequate penile oxygenation by preserving neurovascular bundles and thus erectile function, may play an important role in preventing irreversible penile fibrotic changes (8,14,15). User et al performed a study on postpubertal rats and grouped them according to bilateral or unilateral cavernous nerve transection versus a sham operation (14). They suggested the hypothesis that bilateral injury to the cavernous nerves may induce significant apoptosis of smooth muscle cells particularly in the subtunical area which causes penile fibrosis and abnormality of the veno-occlusive mechanism of the corpus cavernosum.…”

Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy

“…Sustained ED is more likely to be caused by secondary cavernosal trabecular smooth muscle apoptosis and its replacement with collagen. 3,4 Post-prostatectomy ED is severe and may include loss of nocturnal erections, and recovery is slower than generally reported in the literature; many men will not regain erectile function for more than 12 months. 1 ED after prostatectomy is generally treated symptomatically, as needed when intercourse is anticipated.…”

Should penile rehabilitation become the norm following radical prostatectomy?

“…Daley and coauthors 9 reported that the production of prostaglandin E1 was decreased in the cavernosal muscle, which has been previously shown to suppress the TGF-β1-induced collagen accumulation and is also oxygen dependent. Similarly, User and coauthors 10 performed bilateral neurotomy of the rat penis and found that there was a significant increase in apoptosis in the subalbugineal smooth muscle cells. This loss of smooth muscle beneath the tunica leads to venous leak and is evident clinically as venogenic ED.…”