Nerve Grafting and Erectile Dysfunction
Corpus cavernosum neurotization for erectile dysfunction treatment
Erectile dysfunction is the inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance. Non-surgical treatments for PDE5i-refractory erectile dysfunction (Viagra or Cialis) are limited to negative pressure pumps and intra cavernous injections, which are often associated with high dropout rates. Penile prosthesis are associated with up to 17% of adverse complications.
The purpose of nerve transplants is to create new nerve pathways from a donor nerve to the denervated end organs. Souza Trindade in Brazil then Reece in Australia developed the technique that we refined. It’s a nerve grafting between the femoral nerve and directly the cavernous corpus. The goal is to create within 12 months after the nerve transplant, new nerve connections in the corpora cavernosa, which will help to restore erectile function.
The technique is done under general anesthesia by removing the sural nerve located on the lateral side of the leg that leaves a numbness on the external side of the leg (Fig. 1, 2, 3) then we expose the femoral nerves and the cavernous bodies that we connect in microsurgery with the nerve transplant (Fig. 4). Six centimeters of nerve graft is buried into each of the cavernous bodies from a mini opening at the base of the penis. To allow nerve transplants to heal, patients abstain from sexual activity for 3 months.
Significant improvement in erectile function occurs in 70% of men. In men whose erectile function has been restored, more than half will no longer need pharmacological assistance.
Intracavernosal injection of platelet-rich plasma (PRP) as a treatment for erectile dysfunction (ED) is an emerging practice that warrants awareness among primary care physicians and urologists alike. Epidemiologic studies have shown that ED is a highly prevalent condition, affecting more than 300 million men globally, and the use of regenerative medicine, such as stem cells, to reverse ED is highly desired
Platelets play a crucial role in coagulation and promoting wound healing following injury and contain various growth factors (eg, fibroblast growth factor [FGF], platelet-derived growth factor [PDGF], vascular endothelial growth factor [VEGF]) responsible for regenerative functions, including the recruitment of stem cells, modulation of inflammatory responses, and stimulation of angiogenesis. Therefore, the possibility of using platelet-rich concentrates to promote recovery in damaged tissues is exciting. PRP is an autologous product obtained from whole blood that contains high concentrations of platelet growth factors and provides a fibrin framework over platelets that has the potential to support the regenerative matrix.
What Benefits Can a Man Have from the P-Shot?
While there has been no clear evidence published in medical literature, there are several reports of:
How Is PRP Acquired?
A small amount of blood is drawn at the time of the procedure. Your blood is then spun in a specially designed centrifuge which separates the platelets and plasma from the rest of the blood. The platelets are isolated and then injected back into the body wherever their benefits are needed. Numbing cream is used on the skin of the penis so the entire procedure is painless.
How Long Does the P-Shot Procedure Take to Perform?
The PRP injection is performed in our office. It should take about 60 minutes from start to finish but we do usually allow a little extra time. You may drive yourself home after the procedure.
Is There Anything Else That I Will Need to Do After the Procedure?
Yes. Using a VED (Vacuum Erection Device) is essential for achieving optimal success from the procedure. This is usually done twice daily. It requires only a few minutes of your time and without it, success rates are usually lower. We will walk you through it the first time.
When Can I Resume Sexual Activity After the P-Shot Procedure?
You may resume sexual activity after 24 hours.
What Are the Potential Side Effects of the P-Shot?
Since PRP is extracted from your own blood, there are few and only minor potential side effects. These include minor bleeding or bruising, swelling, and very rarely infection."