Intra-operative Neuromodulation of the Pelvic Plexus

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the feasibility of electrical stimulation of nerves responsible for erectile function to evoke penile erection after surgery to remove the prostate (prostatectomy).

Detailed Description
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Prostate cancer is the main cancer in men. However, the survival rate for clinically localized prostate cancer is prominent mainly due to radical prostatectomy (RP), the gold standard treatment for non-metastatic cancers. Unfortunately, despite providing optimal cancer control, RP often lead to neuropraxia and persistent erectile dysfunction in approximately 80% of men 1 year after prostatectomy. Various erectile rehabilitation strategies have not been able to prove a beneficial action yet. However, electrical stimulation has been demonstrated to favour neuroregeneration and the functional recovery of neuromuscular systems and has been shown to induce and maintain penile erection in animals and humans. Therefore, electrical stimulation of the pelvic plexus nerves during radical prostatectomy is being investigated for its potential development into a treatment aimed at improving recovery of erectile function after prostatectomy. The primary objective of this study is to explore the feasibility of using a neurostimulation device post radical prostatectomy as a method for neurogenic erectile dysfunction treatment. During standard open radical prostatectomy, the pelvic plexus nerves will be electrically stimulated intraoperatively and the modification of penile circumference will be recorded. The secondary objective is to assess proper placement of the stimulation electrodes and stimulation parameters needed to achieve maximal change in penile circumference.

Official Title
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Intra-operative Neuromodulation of the Pelvic Plexus

Conditions
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Erectile Dysfunction, Prostate Cancer

Intervention / Treatment
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* Device: Nerve Stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Scheduled for open radical prostatectomy procedure under total anesthesia. Age 40 to 75 years old. Able to read and understand patient information materials and willing to sign a written informed consent. Exclusion Criteria: Have been diagnosed with severe vasculogenic erectile dysfunction. Have a prior history of pelvic surgery, trauma or irradiation therapy. Have a penile prosthesis. Have been diagnosed with neurologic diseases that may negatively impact erectile functions. Currently having an active implantable device (such as a pacemaker). Posses any other characteristics that, per the investigator's judgment, may increase the risk or impair data collection for the procedure/study. Inability to provide a fully informed consent.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Device Feasibility
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nerve Stimulation<br>Acute placement of electrodes and electrostimulation of the pelvic plexus nerves during open radical prostatectomy. | Device: Nerve Stimulation<br>* Acute placement of electrodes on the pelvic plexus to apply electrostimulation during open radical prostatectomy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Penile circumference increase in millimeters. | Change in penile circumference [mm] in response to electrical stimulation of the pelvic plexus nerves measured by a penile plethysmograph. | 5 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anatomic location of stimulation site | The anatomic location of the stimulation site on the pelvic floor (determined by the surgeon). | 5 to 15 minutes | 
| Stimulation threshold in volts | Amplitude in volts of the electrical stimulation pulses to induce penile response. | 5 to 15 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Erectile Dysfunction, Prostate Cancer, Neuromodulation