Dick Brian, Greenberg Jacob W, Polchert Michael, Moore Max, Kim Joseph, Belding Cameron, Kim Hogyoung, Sikka Suresh C, Abdel-Mageed Asim, Halat Shams, Hellstrom Wayne J G
Department of Urology, University of California San Francisco, San Francisco, CA, USA.
Department of Urology, School of Medicine, Tulane University, New Orleans, LA, USA.
Transl Androl Urol. 2023 Aug 31;12(8):1219-1228. doi: 10.21037/tau-23-53. Epub 2023 Aug 4.
Prostate cancer is the most common solid-organ malignancy in adult men. Early detection and treatment of prostate cancer with radical prostatectomy (RP) has improved cancer-specific survival but is associated with penile shortening and erectile dysfunction. Penile traction therapy (PTT) has been demonstrated to increase stretched penile length (SPL) prior to penile prosthesis placement and may improve erectile function (EF) in patients with Peyronie's disease. We aimed to evaluate the efficacy of PTT in preserving penile length and EF after bilateral cavernous nerve crush injury (BCNI) in a rat model.
Twenty-four male Sprague-Dawley rats aged 11-13 weeks were randomly assigned to three groups (n=8, each): sham operation with no PTT (Sham), BCNI without PTT (Crush), and BCNI with PTT (Traction). PTT was started on postoperative day 3. A traction force of 1 Newton was applied to the penis for 30 minutes each day for 28 days. After 28 days of traction, the cavernous nerve was stimulated while recording the intracavernosal pressure (ICP) and the mean arterial pressure (MAP) simultaneously. Cavernosal tissue was excised, and western blot analysis for endothelial nitric oxide synthase (eNOS) was performed. Significance was determined by using ANOVA with Tukey-Kruger post-hoc testing.
At 4 weeks after nerve injury, the Traction group had significantly greater SPL compared to the Sham and Crush groups (30 28 and 27 mm, respectively). The Sham group had significantly greater EF (ΔICP/MAP) compared to the Crush group at 2.5, 5, and 7.5 V. The EF of the Traction group was between that of the Sham and Crush groups and was not significantly different from the Sham group at any voltages. Further downstream analysis revealed that the Traction group had significantly greater eNOS expression in cavernosal tissue compared to the Crush group, which was confirmed on western blot analysis and immunohistochemistry (IHC) staining.
Findings from this animal study suggest that PTT has the potential to mitigate penile retraction after RP. While more studies are needed to determine the effect of PTT on preservation of EF, the increased eNOS expression observed in the Traction group offers a potential protective mechanism of action.
前列腺癌是成年男性中最常见的实体器官恶性肿瘤。早期通过根治性前列腺切除术（RP）检测和治疗前列腺癌可提高癌症特异性生存率，但会导致阴茎缩短和勃起功能障碍。阴茎牵引疗法（PTT）已被证明可在阴茎假体植入前增加阴茎拉伸长度（SPL），并可能改善佩罗尼氏病患者的勃起功能（EF）。我们旨在评估PTT在大鼠双侧海绵体神经挤压伤（BCNI）模型中保留阴茎长度和EF的疗效。
将24只11 - 13周龄的雄性Sprague-Dawley大鼠随机分为三组（每组n = 8）：未进行PTT的假手术组（假手术组）、未进行PTT的BCNI组（挤压组）和进行PTT的BCNI组（牵引组）。PTT于术后第3天开始。每天对阴茎施加1牛顿的牵引力，持续30分钟，共28天。牵引28天后，刺激海绵体神经，同时记录海绵体内压（ICP）和平均动脉压（MAP）。切除海绵体组织，进行内皮型一氧化氮合酶（eNOS）的蛋白质印迹分析。采用方差分析和Tukey-Kruger事后检验确定显著性。
神经损伤后4周，牵引组的SPL显著大于假手术组和挤压组（分别为30、28和27毫米）。在2.5、5和7.5伏时，假手术组的EF（ΔICP/MAP）显著大于挤压组。牵引组的EF介于假手术组和挤压组之间，在任何电压下与假手术组均无显著差异。进一步的下游分析显示，与挤压组相比，牵引组海绵体组织中的eNOS表达显著更高，这在蛋白质印迹分析和免疫组织化学（IHC）染色中得到证实。
这项动物研究的结果表明，PTT有可能减轻RP后的阴茎回缩。虽然需要更多研究来确定PTT对保留EF的影响，但在牵引组中观察到的eNOS表达增加提供了一种潜在的保护作用机制。
