Sexual dysfunction and urinary incontinence are both common side effects following prostate cancer surgery and inadvertent nerve injury occurring during the surgery is believed to be one of the primary causes.[1, 2] To avoid nerve damage during surgery, surgeons typically employ a nerve-sparing procedure and although these nerves-sparing procedures have significantly reduced the incidence of sexual dysfunction and incontinence following prostatectomy surgery, literature still reports
38% – 40% of patients experience sexual dysfunction 
20% – 44% of patients are incontinent 12 months after “successful” nerve-sparing, robotic-assisted prostatectomy surgery 
There are two types of nerves responsible for controlling sexual function and urinary continence – autonomic nerves and somatic nerves. Both types of nerves are too small to be seen, as a result, surgeons must rely on anatomic landmarks to determine what tissue to avoid to keep from damaging them during the surgery. The nerve-sparing procedures the surgeons currently perform rely on these landmarks. Unfortunately, published literature has shown the location of the somatic nerves involved in sexual function and continence control vary considerably and these anatomic landmarks are not always reliable in identifying where they are. [5, 6, 7]
The solution to identifying these critical somatic nerves – the ProPep® Nerve Monitoring System.
The ProPep® Nerve Monitoring System consists of:
- Pep Monitor® – generates the specific electrical signal used to stimulate the tissue of interest, and records, analyzes and displays the response to that signal.
- Pep Control Switch® – enables the surgeon to switch the robotic surgical instrument from cautery mode to stimulation mode and back. (The electrical stimulation signal generated by the Pep Monitor is delivered through the surgeon’s robotic surgical instrument thus eliminating the need to introduce a separate stimulation probe into the surgical field.)
- Pep Electrode® Kit – a single use disposable, containing the Pep Electrode® and the Pep Electrode® Introducer. The Pep Electrode® is connected to the Pep Monitor® and introduced into the surgical field via the Pep Electrode® Introducer. Once in the surgical field, the Pep Electrode® is placed in the tissue of interest to receive the electrical signals generated as a result of tissue stimulation.
2. Shafik A. Pudendal canal decompression in the treatment of erectile dysfunction. Arch Androl. 1994 Mar-Apr; 32(2): 141-9.
3. Rafael F. Coelho, M.D., Bernardo Rocco, M.D., Manoj B. Patel, M.D., et al. Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers. JOURNAL OF ENDOUROLOGY Vol. 24, No.12, December 2003-2015.
4. Lavoisier P, Proulx J, Courtois F, De Carufel F, Durand L-G. Relationship between muscle contractions, penile tumescence, and penile rigidity during nocturnal erections. J Urol. 1988 Jan; 139: 176 -9.
5. Zvara P, Carrier S, Kour N-W, Tanagho EA. The detailed neuroanatomy of the human striated urethral sphincter. BJU. 1994; 74: 182 – 187.
6. Akita K, Sakamoto H, Sato T. Origins and courses of the nervous branches to the male urethral sphincter. Surg Radiol Anat. 2003; 25: 387 – 392
7. Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL. Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J. Surg. 2004: 74: 23 – 26
8. Sabine Geiger-Gritsch, Wilhelm Oberaigner, Nikolai, et al. Patient-Reported Urinary Incontinence and Erectile Dysfunction Following Radical Prostatectomy: Results from the European Prostate Centre Innsbruck. Urologia Internationalis. 2015; 419-427. DOI: 10.1159/000369475