Molecular Pathophysiology of Cavernous Nerve Injury and Identification of Strategies for Nerve Function Recovery After Radical Prostatectomy
Molecular Pathophysiology of Cavernous Nerve Injury and Identification of Strategies for Nerve Function Recovery After Radical Prostatectomy
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DOI：
10.2174/1389450116666150316224456
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发表时间：
2015-01-01
影响因子：
3.2
通讯作者：
Albersen, Maarten
中科院分区：
文献类型：
--
作者：
Weyne, Emmanuel;Mulhall, John;Albersen, Maarten
尽管神经保留技术，勃起功能障碍仍然是常见的根治性前列腺切除术后，由于在手术过程中海绵体神经的神经失用症。根治性尿道切除术后勃起功能的保护和康复仍然具有挑战性，许多男性在临床实践中使用现有的治疗方法治疗不足。在这篇文章中，我们提供了一个全面的概述，在根治性前列腺切除术中发生的神经损伤的病理生理学，并描述了不同的策略，旨在加强神经保护和再生的海绵体神经，以提高勃起功能恢复。这些策略包括免疫调节、神经营养、生长因子和干细胞治疗，在海绵体神经损伤后的大鼠动物模型中令人信服地显示出改善的勃起功能和恢复。此外，我们从神经元恢复的角度描述了用PDE 5i进行阴茎康复的基本原理。许多这些策略审查有可能优化勃起功能恢复后，根治性前列腺切除术从临床前模型转化为临床实践。
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.