Various technologies have been applied during nerve-sparing radical prostatectomy to visualize cavernous nerves involved in penile erection for the purpose of executing pelvic surgeries proficiently while maximizing erection preservation postoperatively. However, these technologies failed to identify the cavernous nerves reliably and guide surgical procedures for improving surgical outcomes. The development of new approaches that accurately and rapidly identify cavernous nerves relevant for penile erection (erectogenic cavernous nerves) in real time during surgery is warranted. In this review, we describe technologies for cavernous nerve visualization, which have been investigated mostly in small rodent animal models. We further discuss recent technological advancements for peripheral nerve localization generally, which may be transferable to cavernous nerve localization. While many of these innovative approaches remain under investigation in preclinical studies, they may serve as a foundation for designing and developing strategies in this arena clinically. Future research should aim to target novel molecular targets and apply these to existing and novel technologies for erectogenic cavernous nerve intraoperative visual imaging.

Keywords: fluorescence; multimodal imaging; near-infrared imaging; nitric oxide; phosphorylated neuronal nitric oxide synthase