Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

Michael J. Whalen
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引用次数: 2

Abstract

Erectile dysfunction is a known and much-dreaded functional consequence of radical prostatectomy. Dr. Patrick Walsh pioneered the nerve-sparing radical retropubic prostatectomy in the early 1980s, which has mitigated the morbidity of this surgery. Post- operative potency rates range widely from 20 to 80%, however, and depend on myriad factors including age, preoperative potency, and degree of nerve-sparing during surgery. Over the past four decades several developments have continued to offer hope to patients and clinicians alike, including refined understanding of cavernosal nerve neuroanatomy, beneficial modifications in surgical technique, as well as the advent of robotic surgery. Furthermore, multiple pre- and post-operative penile rehabilitation techniques using mechanotherapy and pharmaceuticals have also improved functional recovery. This paper examines erectile dysfunction as a consequence of radical prostatectomy, including the physiology of erections, the pathophysiology of post-operative erectile dysfunction, novel surgical techniques to enhance neurovascular bundle preservation, and penile reha- bilitation strategies involving hyperbaric oxygen, neuroprotective pharmaceuticals, dehydrated human amnion-chorion membrane allografts, and mesenchymal stem cell therapy.
根治性前列腺切除术后预防勃起功能障碍:神经保留技术、阴茎康复和新的再生疗法
勃起功能障碍是根治性前列腺切除术的一个众所周知且非常可怕的功能后果。Patrick Walsh医生在20世纪80年代早期开创了保留神经的根治性耻骨后前列腺切除术,这降低了该手术的发病率。然而,术后效力率从20%到80%不等,这取决于许多因素,包括年龄、术前效力和手术中神经保留的程度。在过去的四十年里,一些发展继续为患者和临床医生带来希望,包括对海绵体神经解剖学的精确理解,手术技术的有益改进,以及机器人手术的出现。此外,使用机械疗法和药物的多种术前和术后阴茎康复技术也改善了功能恢复。本文研究了根治性前列腺切除术后的勃起功能障碍,包括勃起的生理学、术后勃起功能障碍的病理生理学、增强神经血管束保存的新手术技术,以及包括高压氧、神经保护药物、脱水人羊膜-绒毛膜异体移植和间充质干细胞治疗在内的阴茎康复策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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