Despite nerve-sparing techniques, erectile dysfunction remains commonly observed after
radical prostatectomy due to neuropraxia to the cavernous nerves during surgery. Preservation and rehabilitation
of erectile function after radical prostatectomy remains challenging and many men stay
undertreated with the current armory of therapies available in clinical practice. In this article we provide
a comprehensive overview of the pathophysiology of the nerve injury occurring during radical
prostatectomy and describe different strategies aimed at enhancing neuroprotection and regeneration of
the cavernous nerves in order to improve erectile function recovery. These strategies include immunomodulatory,
neurotrophic, growth factor and stem cell therapy have convincingly shown improved erectile function and
recovery in rat animal models after cavernous nerve injury. Furthermore we describe the rationale for penile rehabilitation
with PDE5i out of a neuronal recovery point of view. Many of these strategies reviewed have the potential to optimize
erectile function recovery after radical prostatectomy when translated from pre-clinical models to clinical practice.
Keywords: Cavernous nerve injury, erectile dysfunction, immunomodulatory, nerve graft, nerve growth factor, neuromodulatory,
PDE5-inhibitor, radical prostatectomy.
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