Abstract
Purpose
In this study, prophylactic penile rehabilitation (PR) with sildenafil before and after a cavernosal nerve (CN) injury was analyzed in an animal model.
Materials and methods
Thirty-six animals were divided into six groups as follows: (1) those with no CN injury (i.e., sham), (2) those with a bilateral CN injury (i.e., control), (3, 4) those with a bilateral CN injury treated with 10–20 mg/kg of sildenafil subcutaneously (SC) on a daily basis commencing 1 month prior to and after nerve injuries, respectively, (5, 6) those with a bilateral CN injury treated daily with 10–20 mg/kg of sildenafil SC after the nerve injuries, respectively. Mean arterial pressure (MAP) and intracavernosal pressure (ICP) were measured in response to CN stimulation to assess erectile function (EF). Neuronal nitric oxide synthase (nNOS) immunohistochemical analysis and real-time polymerase chain reaction (RT-PCR) were performed.
Results
The maximal ICP/MAP ratio was 60 ± 18% in the sham, 22 ± 5% in the control, 28 ± 9% in Group III, 45 ± 16% in Group IV, 45 ± 17% in Group V, and 49 ± 21% in Group VI. Although EF was improved with sildenafil treatment in a dose-dependent fashion, no statistically significant difference was observed between the preemptive and standard rehabilitation groups. Again, nNOS immunoreactivity and RT-PCR results showed the beneficial effect of sildenafil, but the study did not support the efficacy of preemptive rehabilitation when compared to the standard rehabilitation group.
Conclusions
Although, a dose–response relationship was observed for PR treatment with sildenafil; i.e., outcomes improved at higher doses of sildenafil for PR, preemptive PR should not be pursued as an alternative rehabilitation modality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Stephenson RA, Mori M, Hsieh YC et al (2005) Treatment of erectile dysfunction following therapy for clinically localized prostate cancer: patient reported use and outcomes from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study. J Urol 174:646–650 discussion 650
Loeb S, Hernandez DJ, Mangold LA et al (2008) Progression after radical prostatectomy for men in their thirties compared to older men. BJU Int 101(12):1503–1506
Secin FP, Touijer K, Mulhall J et al (2007) Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol 51:1229–1235
Walsh PC, Marschke P, Ricker D et al (2000) Use of intraoperative video documentation to improve sexual function after radical retropubic prostatectomy. Urology 55:62–67
Montorsi F, Salonia A, Suardi N et al (2005) Improving the preservation of the urethral sphincter and neurovascular bundles during open radicalretropubic prostatectomy. Eur Urol 48:938–945
Walsh PC, Marschke P, Ricker D et al (2000) Patient reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55:58–61
Rabbani F, Stapleton AM, Kattan MW et al (2000) Factors predicting recovery of erections after radical prostatectomy. J Urol 164:1929–1934
Schover LR, Fouladi RT, Warneke CL et al (2002) Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer 95:1773–1785
Zippe CD, Pahlajani G (2007) Penile rehabilitation following radical prostatectomy: role of early intervention and chronic therapy. Urol Clin North Am 34:601–618
Ferrini MG, Davila HH, Kovanecz I et al (2006) Vardenafil prevents fibrosis and loss of corporal smooth muscle that occurs after bilateral cavernosal nerve resection in the rat. Urology 68(2):429–435
Mulhall JP, Morgentaler A (2007) Penile rehabilitation should become the norm for radical prostatectomy patients. J Sex Med 4:538–543
Mulhall JP, Müller A, Donohue JF et al (2008) The functional and structural consequences of cavernous nerve injury are ameliorated by sildenafil citrate. J Sex Med 5(5):1126–1136
Mullerad M, Donohue JF, Li PS et al (2006) Functional sequelae of cavernous nerve injury in the rat: is there model dependency. J Sex Med 3:77–83
Park KH, Kim SW, Kim KD et al (1999) Effects of androgens on the expression of nitric oxide synthase mRNAs in rat corpus cavernosum. BJU Int 83(3):327–333
User HM, Hairston JH, Zelner DJ et al (2003) Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol 169:1175–1179
Behr-Roussel D, Gorny D, Mevel K et al (2005) Chronic sildenafil improves erectile function and endothelium-dependent cavernosal relaxations in rats: lack of tachyphylaxis. Eur Urol 47(1):87–91
Kovanecz I, Rambhatla A, Ferrini M et al (2008) Long-term continuous sildenafil treatment ameliorates corporal veno-occlusive dysfunction (CVOD) induced by cavernosal nerve resection in rats. Int J Impot Res 20(2):202–212
Michl U, Graefen M, Haese A et al (2008) Erection, potency, continence, and QOLl of contemporary patients scheduled for retropubic prostatectomy. An unknown preoperative problem. Analysis of patients with validated questionnaires (IIEF5, QLQ-C30, ICS-BPH SF). Eur Urol Suppl 7(3):162
Schwartz EJ, Wong P, Graydon RJ (2004) Sildenafil preserves intracorporeal smooth muscle after radical retropubic prostatectomy. J Urol 171:771–774
Andersson K-E (2001) Pharmacology of penile erection. Pharmacol Rev 53:417–450
Nangle MR, Keast JR (2007) Reduced efficacy of nitrergic neurotransmission exacerbates erectile dysfunction after penile nerve injury despite axonal regeneration. Exp Neurol 207(1):30–41
Acknowledgments
F. Tuncay Aki, Levent Gürkan. Supported by Marmara University Medical Faculty Foundation and Turkish Urological Association.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tavukçu, H.H., Akbal, C., Tinay, İ. et al. Outcome of preemptive penile rehabilitation before bilateral cavernosal nerve injury in rats. World J Urol 28, 735–740 (2010). https://doi.org/10.1007/s00345-009-0495-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-009-0495-9