Extrapelvic cavernous nerve stimulation in erectile dysfunction. Human study.

An extrapelvic subpubic approach was used in dogs to stimulate the cavernous nerve (CN) with a resulting increase in the intracavernous pressure and full erection. This approach was used for the treatment of erectile dysfunction (ED) in 15 men with a mean age of 42.6 years (range from 32 to 55 years). Routine erectile function tests showed normal readings for endocrine assay, Doppler examination of the penile arteries, penobrachial pressure index and cavernosometry. Nocturnal penile tumescence was absent. The CN was exposed through a parapenile incision. The suspensory ligament was divided and the CN searched for in the area bounded by symphysis pubis, penile crura and urethra. A bipolar platinum electrode was implanted around CN and connected to a subcutaneous receiver. Implantation was performed bilaterally in eight subjects and unilaterally in seven. Two weeks after the operation, the CN was stimulated. CN stimulation at 10 Hz frequency led to penile tumescence but no rigidity; intracavernous pressure increased (P < 0.01). Upon increase of stimulation frequency, the penile tumescence as well as rigidity and pressure increased until full erection was achieved at 60 Hz. The latency and stimulation phase decreased with increase of stimulation frequency. Unilateral nerve stimulation induced erection as well. In conclusion, CN stimulation induced full erection in ED. The technique is extrapelvic and safe.