- Email: [email protected]
Editorial Comment on: Apoptosis and Effects of Intracavernous Bone Marrow Cell Injection in a Rat Model of Postprostatectomy Erectile Dysfunction
EUROPEAN UROLOGY 56 (2009) 716–726
[28] Napoli C, Williams-Ignarro S, de Nigris F, et al. Beneficial effects of concurrent autologous bone marrow cell therapy and metabolic intervention in ischemia-induced angiogenesis in the mouse hind limb. Proc Natl Acad Sci USA 2005;102:17202–6. [29] Zhong C, Qin Z, Zhong CJ, Wang Y, Shen XY. Neuroprotective effects of bone marrow stromal cells on rat organotypic hippocampal slice
Editorial Comment on: Apoptosis and Effects of Intracavernous Bone Marrow Cell Injection in a Rat Model of Postprostatectomy Erectile Dysfunction Rafael Badalyan Urology Department, National Institute of Health, Yerevan, Armenia [email protected] Although short- and long-term oncologic results and continence rates after bilateral nerve-sparing radical prostatectomy (BNSRP) are excellent, the preservation and rehabilitation of sexual function continues to be a challenge. BNSRP preserves potency in 31–86% of sexually active men with organ-confined disease. The aetiology of impotence following radical prostatectomy is multifactorial, but neurogenic factors seem to play a major role. The most important prognostic factors for recovery of sexual potency are the number of spared neurovascular bundles, age, and sexual activity before the operation [1]. In this respect, the paper by Fall and coworkers [2] sheds light on pathophysiologic aspects of post–radical prostatectomy erectile dysfunction (pPED), emphasising the role of apoptosis after cavernous nerve ablation, which can play a key role in this postoperative complication. As shown in this animal model study, even with the restoration of neuronal pathways after 5 wk from nerve ablation, proven by elevated neuronal and endothelial nitrous oxide synthase (NOS), intracavernous pressure remains impaired, confirming the damage of cavernous tissues. We hope that, after these promising results, the authors will continue investigations to show cavernosal and neuronal changes after BNSRP in long-term studies. The protective effect of bone-marrow mononucleated cells (BMMNCs) on cardiomyocytes has been previously proven [3]. Intracavernous delivery of BMMNCs following bilateral cavernous nerve ablation (BCNA) protected
Editorial Comment on: Apoptosis and Effects of Intracavernous Bone Marrow Cell Injection in a Rat Model of Postprostatectomy Erectile Dysfunction Alan W. Shindel, Tom F. Lue Department of Urology, University of California at San Francisco, San Francisco, California, USA [email protected]
725
culture model of cerebral ischemia. Neurosci Lett 2003;342: 93–6. [30] Mulhall J, Land S, Parker M, Waters WB, Flanigan RC. The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med 2005;2:532–40, discussion 540–2.
against cavernous cell apoptosis and improved the erectile response. These findings may become fundamental for delivering novel treatment options for erectile dysfunction not only following radical prostatectomy but in other pathologies leading to cavernosal dysfunction as well as to sclerosis. The role of androgens in regulation of cavernosal tissue formation and function is irrefutable, and removal of the prostate gland when testosterone is converted into 10 times more active androgen-dihydrotestosterone may also play a critical role in cavernosal apoptosis after radical prostatectomy and cystprostatectomy. The latter should be taken into account in future investigations to maximally approach the pathophysiologic mechanism of the impairment. Preservation and rehabilitation of sexual function after treatment of localised prostate cancer continues to be challenging, and the authors are to be congratulated for the excellent study on this important issue.
References [1] Dubbelman YD, Dohle GR, Schro¨der FH. Sexual function before and after radical retropubic prostatectomy: a systematic review of prognostic indicators for a successful outcome. Eur Urol 2006;50:711–20. [2] Fall PA, Izikki M, Tu L, et al. Apoptosis and effects of intracavernous bone marrow cell injection in a rat model of postprostatectomy erectile dysfunction. Eur Urol 2009;56:716–26. [3] Perin EC, Dohmann HF, Borojevic R, et al. Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation 2003;107:2294–302.
DOI: 10.1016/j.eururo.2008.09.060 DOI of original article: 10.1016/j.eururo.2008.09.059
There has been great interest over the past several years in the development of therapies designed to actually reverse the underlying causes of erectile dysfunction (ED), thereby obviating the need for as-needed treatments for the condition. Researchers have investigated a variety of interventions, such as gene therapy and daily dosing of phosphodiesterase type 5 inhibitors (PDE5-Is), as methods to preserve cavernosal tissue integrity and nervous
[28] Napoli C, Williams-Ignarro S, de Nigris F, et al. Beneficial effects of concurrent autologous bone marrow cell therapy and metabolic intervention in ischemia-induced angiogenesis in the mouse hind limb. Proc Natl Acad Sci USA 2005;102:17202–6. [29] Zhong C, Qin Z, Zhong CJ, Wang Y, Shen XY. Neuroprotective effects of bone marrow stromal cells on rat organotypic hippocampal slice
Editorial Comment on: Apoptosis and Effects of Intracavernous Bone Marrow Cell Injection in a Rat Model of Postprostatectomy Erectile Dysfunction Rafael Badalyan Urology Department, National Institute of Health, Yerevan, Armenia [email protected] Although short- and long-term oncologic results and continence rates after bilateral nerve-sparing radical prostatectomy (BNSRP) are excellent, the preservation and rehabilitation of sexual function continues to be a challenge. BNSRP preserves potency in 31–86% of sexually active men with organ-confined disease. The aetiology of impotence following radical prostatectomy is multifactorial, but neurogenic factors seem to play a major role. The most important prognostic factors for recovery of sexual potency are the number of spared neurovascular bundles, age, and sexual activity before the operation [1]. In this respect, the paper by Fall and coworkers [2] sheds light on pathophysiologic aspects of post–radical prostatectomy erectile dysfunction (pPED), emphasising the role of apoptosis after cavernous nerve ablation, which can play a key role in this postoperative complication. As shown in this animal model study, even with the restoration of neuronal pathways after 5 wk from nerve ablation, proven by elevated neuronal and endothelial nitrous oxide synthase (NOS), intracavernous pressure remains impaired, confirming the damage of cavernous tissues. We hope that, after these promising results, the authors will continue investigations to show cavernosal and neuronal changes after BNSRP in long-term studies. The protective effect of bone-marrow mononucleated cells (BMMNCs) on cardiomyocytes has been previously proven [3]. Intracavernous delivery of BMMNCs following bilateral cavernous nerve ablation (BCNA) protected
Editorial Comment on: Apoptosis and Effects of Intracavernous Bone Marrow Cell Injection in a Rat Model of Postprostatectomy Erectile Dysfunction Alan W. Shindel, Tom F. Lue Department of Urology, University of California at San Francisco, San Francisco, California, USA [email protected]
725
culture model of cerebral ischemia. Neurosci Lett 2003;342: 93–6. [30] Mulhall J, Land S, Parker M, Waters WB, Flanigan RC. The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med 2005;2:532–40, discussion 540–2.
against cavernous cell apoptosis and improved the erectile response. These findings may become fundamental for delivering novel treatment options for erectile dysfunction not only following radical prostatectomy but in other pathologies leading to cavernosal dysfunction as well as to sclerosis. The role of androgens in regulation of cavernosal tissue formation and function is irrefutable, and removal of the prostate gland when testosterone is converted into 10 times more active androgen-dihydrotestosterone may also play a critical role in cavernosal apoptosis after radical prostatectomy and cystprostatectomy. The latter should be taken into account in future investigations to maximally approach the pathophysiologic mechanism of the impairment. Preservation and rehabilitation of sexual function after treatment of localised prostate cancer continues to be challenging, and the authors are to be congratulated for the excellent study on this important issue.
References [1] Dubbelman YD, Dohle GR, Schro¨der FH. Sexual function before and after radical retropubic prostatectomy: a systematic review of prognostic indicators for a successful outcome. Eur Urol 2006;50:711–20. [2] Fall PA, Izikki M, Tu L, et al. Apoptosis and effects of intracavernous bone marrow cell injection in a rat model of postprostatectomy erectile dysfunction. Eur Urol 2009;56:716–26. [3] Perin EC, Dohmann HF, Borojevic R, et al. Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation 2003;107:2294–302.
DOI: 10.1016/j.eururo.2008.09.060 DOI of original article: 10.1016/j.eururo.2008.09.059
There has been great interest over the past several years in the development of therapies designed to actually reverse the underlying causes of erectile dysfunction (ED), thereby obviating the need for as-needed treatments for the condition. Researchers have investigated a variety of interventions, such as gene therapy and daily dosing of phosphodiesterase type 5 inhibitors (PDE5-Is), as methods to preserve cavernosal tissue integrity and nervous