ABSTRACT
In the burgeoning hybrid discipline of neurourology, neuromodulatory therapy for erectile dysfunction has come to be recognized as a scientifically and clinically important subject area. Such therapy aims to restore and promote the neurologic health of the lower genitourinary tract, threatened by disease or injury including iatrogenic surgical trauma. Many urologists know of the pioneering modifications of radical prostatectomy described by Walsh approximately 25 years ago, which showcased the innovation of ‘nerve-sparing’.1 The advance established the importance of maintaining the structural integrity of autonomic, erection-mediating cavernous nerves coursing adjacent to the prostate when performing radical prostatectomy to maximize postsurgical erectile function outcomes. Importantly, the new approach to the procedure was shown not to compromise the oncologic objectives of the surgery. In current practices when the surgery is performed according to principles of anatomic dissection with the application of cavernous nerve preservation techniques, postoperative erectile function recovery rates have certainly improved compared with those of the prior surgical era in which complete erectile dysfunction was universally observed postoperatively.2,3
The advance of anatomic radical prostatectomy with cavernous nerve preservation techniques is also credited with paving the way for more recently explored neuroprotective and nerve regenerative therapeutic strategies for erectile preservation. In concept, these strategies refer to both surgical and medical therapeutic innovations directly relevant for neurogenic erectile dysfunction. At the same time, such strategies may offer therapeutic benefit for various functions in the pelvic region which involve nerve-dependent actions. In the example of applying neuromodulatory strategies for pelvic surgery such as radical prostatectomy, other conditions that may be improved include urinary continence and even alleviation of postsurgical neuropathic pain.
