If penile apoptosis could be prevented following prostatectomy while the CN regenerates, then resumption of normal erectile function would occur more quickly and fibrosis would be prevented as the tissue tries to regenerate. This would lead to long-term prevention of ED. Investigation of the factors that regulate apoptosis in the penis and the role that neural innervation plays in this process is a necessity to move the field of ED research forward and to develop new treatment strategies. A recently identified regulator of penile morphology that has been shown to orchestrate apoptosis induction during embryogenesis of the penis is the morphogen Sonic hedgehog (SHH).
We have shown in previous studies that the SHH signaling pathway is critical for establishing the sinusoid morphology of the corpora cavernosa during development and that SHH continues to function in the adult organ to regulate and maintain penile morphology. Inhibition of SHH signaling in normal adult rats caused abundant apoptosis and remodeling of the sinusoidal architecture of the corpora cavernosa, so that sinusoids were completely absent.