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Novel methods for mapping the cavernous nerves during radical prostatectomy

Nature Reviews Urology volume 12, pages 451–460 (2015)Cite this article

Subjects

Key Points

  • The identification and preservation of the cavernous nerves during radical prostatectomy is challenging, resulting in widely variable rates of postoperative sexual function

  • Current experimental diagnostic techniques include electrical and optical stimulation, fluorescence, microscopy, spectroscopy, ultrasonography and magnetic resonance imaging

  • These current techniques are limited by slow or inconsistent nerve responses, limited resolution, shallow imaging depth, slow image acquisition times and/or safety concerns

  • A single technology has not yet emerged as the preferred option for improving nerve-sparing radical prostatectomy

  • Multimodal approaches that combine complementary diagnostic techniques, anatomical and functional imaging and robotics might overcome some of the limitations and provide a better option

Abstract

The cavernous nerves, which course along the surface of the prostate gland, are responsible for erectile function. During radical prostatectomy, urologists are challenged in preserving these nerves and their function. Cavernous nerves are microscopic and show variable location in different patients; therefore, postoperative sexual potency rates are widely variable following radical prostatectomy. A variety of technologies, including electrical and optical nerve stimulation, dye-based optical fluorescence and microscopy, spectroscopy, ultrasound and magnetic resonance imaging have all been used to study cavernous nerve anatomy and physiology, and some of these methods are also potential intraoperative methods for identifying and preserving cavernous nerves. However, all of these technologies have inherent limitations, including slow or inconsistent nerve responses, poor image resolution, shallow image depth, slow image acquisition times and/or safety concerns. New and emerging technologies, as well as multimodal approaches combining existing methods, hold promise for improved postoperative sexual outcomes and patient quality of life following radical prostatectomy.

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Figure 1: Cross-sectional diagram of the human prostate showing the location of the neurovascular bundles and their close proximity to the prostate surface.
Figure 2: Optical coherence tomography.
Figure 3
Figure 4: An axial T2-weighted MRI of the neurovascular bundles using a 3 T magnet.
Figure 5: Comparative trade-off between resolution and penetration depth for different imaging modalities.

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  1. Department of Physics and Optical Science, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, 28223, NC, USA

    Nathaniel M. Fried

  2. Department of Urology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, 21287-2411, MD, USA

    Arthur L. Burnett

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N.M.F. researched data for the article and wrote the manuscript. A.L.B. contributed to the discussion of content and reviewed/edited the manuscript before submission.

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Fried, N., Burnett, A. Novel methods for mapping the cavernous nerves during radical prostatectomy. Nat Rev Urol 12, 451–460 (2015). https://doi.org/10.1038/nrurol.2015.174

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