Transplantation of Stem/Progenitor Cells: Potential Treatment for Erectile Dysfunction Following Radical Prostatectomy

Abstract

As the maintenance of a satisfactory quality-of-life is recognized as the principle concern for men and sexual dysfunction is an independent determinant of a worse general health-related quality-of-life, practicing urologists have focused on the understanding of the pathophysiology of erectile dysfunction (ED) following radical prostatectomy (RP) with the concepts of instituting prophylactic measures for prevention and early recovery from ED. ED following RP is often the result of inadvertent injury to the cavernous nerves that course along the prostate capsule and innervates the corpora cavernosa of the penis. The introduction of the nerve-sparing procedures to preserve erectile function has been embraced globally and has made for greater acceptance. However, as unassisted nerve regeneration is a slow process, denervation-induced damage, including cavernosal fibrosis and cavernosal smooth muscle apoptosis frequently develops following RP. Pharmacological penile rehabilitation postoperatively with oral or intracavernosal vasoactive drugs is theorized to be of benefit in most patients, allowing for faster and more complete recovery of erectile function. The current belief is that penile rehabilitation programs with available measures maintains erectile tissue integrity and prevents corporal smooth muscle atrophy and collagen production. Studies on neuroprotection and neuroregeneration will help to preserve erectile function following RP.

Emerging evidences from preclinical studies using mesenchymal stem cells (MSCs) have been providing significant data for the future. Although MSCs were originally believed to provide for tissue regeneration through engraftment and long-term survival in injured tissues via their presumed plasticity, accumulating findings suggest a plethora of additional mechanisms, including paracrine mechanisms. In spite of the fact that MSC therapy has shown efficacy in animal models of cavernous nerve injury that reflects the nerve injury following RP and other pelvic surgeries, further research is warranted to overcome a number of translational issues on the path towards clinical application of MSCs for the treatment of post-prostatectomy ED.