Placenta wrap hastens erection recovery after prostate surgery

Erectile dysfunction is common after prostate cancer surgery, but wrapping thin sheets of dried placenta around exposed nerves during the procedure may allow faster recovery. A review of thousands of surgeries suggests that this approach enables an erection within one week of surgery, compared with two weeks without the intervention. “To help men get better erections, we’re using donations [of placentas] from women,” says Shirin Razdan at HCA Florida Kendall Hospital in Miami. Her colleague and father, Sanjay Razdan, also at HCA Florida Kendall Hospital, had the idea to try the technique more than a decade ago. This followed a discussion he had at the hospital cafeteria with some neurosurgeon colleagues, who were investigating whether amniotic membranes from donated placentas could improve nerve healing in their procedures. Advertisement The amniotic membrane is the innermost, fetus-facing layer of the placenta, and is known to be packed with growth factors and immune-modulating proteins that promote healing. Some companies peel the amniotic membrane off placentas that have been donated after Caesarean sections, then dry, sterilise and package it in standard-sized sheets. Between 2014 and 2024, Sanjay Razdan used dried sheets of human amniotic membrane to wrap nerves near the prostate during 2560 radical prostatectomies, surgeries that remove the entire prostate gland to treat cancer. He placed these thin sheets, each measuring 4 by 6 centimetres, on bundles of nerves called cavernous nerves that run along both sides of the prostate. He then wet them with saline to make them cling around the nerves. This is like how moistening dried seaweed sheets allows them to be wrapped around sushi rolls, says Shirin Razdan. Surgeons try to preserve the cavernous nerves when they take out the prostate because they signal for muscles in the penis to relax, so blood can rush in and produce erections. Robotic equipment is commonly used to improve precision, but “even when you do the most beautiful nerve-sparing surgery, there is usually still some damage to the nerves”, says Shirin Razdan. This is because the nerves get stretched and heated by the surgical tools, and general inflammation tends to arise in the area. As a result, it is often difficult to have erections after prostate removal. But applying the amniotic membrane sheets appeared to help. In the 2560 men who received them, the average time to first erection post-surgery was seven days. By comparison, in 1495 men who didn’t receive them, the average time was 14 days. These men were also operated on by Sanjay Razdan, but before 2014. Three months after surgery, 75 per cent of the men who received the amniotic membranes were able to have erections “sufficient for penetration”, compared with 60 per cent for those who didn’t receive them. One risk of applying amniotic membranes to an area that has been affected by cancer is that they might spur further cancer growth, since they are rich in growth factors. However, the study didn’t find any differences in cancer outcomes between the two groups after an average eight-year follow up. A limitation of the study is that it is a retrospective review of procedures by a single surgeon, rather than a clinical trial. It is possible that the better erection outcomes since 2014 are due to refinements in individual surgical technique, but Shirin Razdan says she doesn’t believe this would be enough to explain the significant improvements in erectile recovery. Arthur Burnett at Johns Hopkins Medicine in Maryland says randomised clinical trials will be required to confirm that amniotic membrane nerve wraps do indeed assist erectile function. “I’m pleased to see that they’re trying to think outside the box here, but nobody else is doing this routinely yet. It still needs to be further investigated.” Inspired by her father’s results, Shirin Razdan says she is now applying amniotic membrane nerve wraps when she performs prostate removals, and is trialling them in surgeries for Peyronie’s disease, a condition where scar tissue forms under the skin of the penis and causes painful, curved erections. Outside of urology, dehydrated amniotic membranes are also becoming an increasingly popular option for applying to skin wounds and burns, and have been found to reduce scarring. Research Square DOI: 10.21203/rs.3.rs-10852428/v1