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I am trying to ascertain if there are any new treatments that are being trialled regarding nerve repair following excision of nerves during surgery. I know that there are Doctors who perform 'Sural Nerve Grafting' at the time of surgery where there is damage to the nerves, however it appears that most Australian Doctors hold little faith in this technique for a variety of reasons. I have also heard that overseas they are trialling a product (animal studies only as far as I am aware), called Alginate, a biodegradable polysaccharide, which may be applied to facilitate nerve regeneration. They are attempting to regenerate excised cavernous nerves by filling the gap with a biodegradable alginate gel sponge sheet without sutures. I would be very interested to hear of people's experiences in relation to erectile function following excision to cavernous nerves. Thank you :)
I must confess to never having heard of this issue, but I’m pretty sure you might find someone on Prostate Cancer and Intimacy List who may have some knowledge.
I have found one study, which is below for anyone interested (no doubt you will have seen this, Molly) and I had a quick look on Clinical Trials, one of the sites that lists current trials. Using ‘nerve regeneration’ to search I founf three trials recruiting, but they did not seem to be relevant.
Good luck in your hunt for information – perhaps you could share it with us when you track it down.
Terry in Melbourne, Australia
Cavernous nerve regeneration by biodegradable alginate gel sponge sheet placement without sutures
Urology, Volume 68, Issue 6, December 2006, Pages 1366-1371
Abstract: Objectives: Alginate, a biodegradable polysaccharide, may be applied to facilitate nerve regeneration. We attempted to regenerate excised cavernous nerves by filling the gap with a biodegradable alginate gel sponge sheet without sutures.
Methods: Bilateral cavernous nerves of male Wistar rats were excised to make an approximately 2-mm gap. A piece of freeze-dried alginate sheet was then placed over the gap to cover each stump without suturing (alginate group). We also performed sham operations (sham group) and bilateral nerve excision alone (excision group).
Results: Erection was confirmed visually by mating behavior in 9%, 36% and 73% of alginate rats at 2, 4, and 12 weeks, respectively. In contrast, no excision rats had an erection. At 12 weeks postoperatively, electrical stimulation of the pelvic plexus increased intracavernous pressure in the sham group and alginate rats with restored erectile function. However, no increase occurred in the excision group. In a retrograde neural tracing study with FluoroGold at 12 weeks, rich FluoroGold-positive cells were observed in the sham group and alginate rats with restoration, but very few were found in the excision group. Double-labeled immunochemistry with anti-S-100 and beta-tubulin III antibodies showed that the neural gap was connected with the regenerated nerve fibers at 12 weeks.
Conclusions: The results of our animal study have demonstrated that by simply filling the nerve gap using an alginate sheet, the cavernous nerve can be regenerated and erectile function may be restored.
Re: Re: Nerve repair/regeneration following surgery
Thank you Terry for the information. I have joined the site mentioned and did look through the other site for relevant clinical trials. I did speak to an associate professor who is interested in this area and is looking into 'nerve regeneration' in general and assured me she would contact me if she heard of anything happening in this area around the world. She is based at Royal North Shore Hospital. I feel like we have not moved ahead that much when it comes to the treatment of Erectile Dysfunction and I feel that this is a very important issue that needs to be addressed. I could be wrong, but I feel that not enough people are speaking out about this issue and I understand that it is a very private issue and perhaps not one easily discussed by those affected. I did notice that studies are being undertaken, like you discovered, overseas and I have written to several Universities, no responses as yet unfortunately. Will keep you posted.
Re: Re: Re: Nerve repair/regeneration following surgery
Molly,
I agree with you when you say “I could be wrong, but I feel that not enough people are speaking out about this issue and I understand that it is a very private issue and perhaps not one easily discussed by those affected.” although the relative anonymity of the Internet has helped to ease the discussions.
But I also believe that one of the biggest issues is the “divide and conquer” problem that arises from so many members of the medical profession implying that men who are concerned about erectile dysfunction are in a minority. Combined with the throwaway line ”Dead men don’t have erections” men feel that they have just been unlucky in the side effects while being fortunate that their tumour was discovered early and that they have been ‘saved’.
Although I accept that many of the men who do discuss their erectile issues may not be representative of all the men who have had treatment (on the basis that the men who have no problems may not get involved in any discussion) I still am inclined to the view that there are significantly more men with severe problems than are shown in published studies. Those show the results from centres where a very high number of procedures are carried out by teams that are likely to include the very best surgeons and radiologists. But these teams of excellence cannot treat all the men who choose to have treatment – and they are left to the less skilled, less experienced operators who almost certainly cannot claim the morbidity rates of the teams of excellence.
And of course, it is not only the question of erectile dysfunction that is at issue. Whilst most men are aware of the danger of losing the ability of retaining their erectile ability, very few are aware of the issue of leakage of urine following surgery or the increased risk of Peyronie’s disease, where the penis becomes bent when erected. Yet these, and other, side effects are real, and they occur more frequently than they are reported.
