Histological alterations in cavernous tissue after radical prostatectomy.
OBJECTIVE
Radical prostatectomy often results in erectile dysfunction because of lesions to the erectile nerves. In this study we evaluated histomorphological alterations in cavernous smooth muscle and collagen content after radical prostatectomy.


METHODS
A total of 19 patients between 57 and 69 years old with prostate adenocarcinoma and normal erectile function, as reported and validated by RigiScan (UroHealth Systems, Laguna Niguel, California) testing, underwent corpora cavernosa biopsy in the operating room before radical prostatectomy, and 2 and 12 months after surgery. No patient underwent hormone therapy before or after surgery and none was diabetic. Elastic fibers (manual counting), muscle specific actin (immunostaining) and collagen content (computerized morphometric imaging) were measured in the 3 biopsies.


RESULTS
In all cases the first postoperative histological assessment revealed some disorganization. Trabecular elastic fibers (p <0.0003) and smooth muscle fibers were decreased and collagen content was significantly increased (p <0.0003) compared with preoperative biopsies. One year after surgery elastic fibers (p <0.0003) and smooth muscle fibers were decreased and collagen content was significantly increased (p <0.0003) compared with the first postoperative biopsy. Moreover, organized collagen and trabecular protocollagen deposits were increased.


CONCLUSIONS
Progressive fibrosis in the corpora cavernosa after radical prostatectomy probably results from denervation and/or an ischemic process, which is caused in turn by the ligation of anomalous pudendal artery branches or of venous plexuses that drain to or from the corpora cavernosa. Fibrosis and the subsequent loss in elasticity and function of erectile tissue probably together cause erectile dysfunction.
Iacono
Fabrizio
F
Urologic Clinic and Division of Pathologic Anatomy, University of Naples Federico II, Naples, Italy.
Giannella
Renato
R
Somma
Pasquale
P
Manno
Giuseppe
G
Fusco
Ferdinando
F
Mirone
Vincenzo
V
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000473:pathology*; D011468:Prostatectomy / Q000009:adverse effects