Cavernous Nerves Electrical Stimulation with Penile Plethysmography

The assessment of the function of the cavernous nerves by direct application of electrical stimulation with penile plethysmography is a diagnostic test, also referred to as cavernosal nerve mapping, which may be performed prior to, during, or after a nerve-sparing radical prostatectomy to assess the integrity of the cavernous nerves. Through an open or laparoscopic procedure, most typically performed after a radical prostatectomy, the surgeon may want to assess the function of the cavernous nerves by stimulating the most distal end of the nerve that can be located by using an electrical nerve stimulator. A functioning and stimulated nerve will trigger blood flow either into or out of the penis. A penile plethysmography sensor will have been fitted around the penis and been connected to a nerve stimulator control unit. The sensor detects slight changes in penile girth, which occur when the nerves stimulate a response to cavernous blood flow. If the nerves are intact, there is blood flow. The presence of a response, and the degree of the response may be used to provide the surgeon with a more realistic assessment of the chance of the patient regaining potency and assist in choosing appropriate therapy. It is this use of the procedure during both open and post-radical prostatectomy that the requestor has asked us to review and not its use prior to a prostatectomy. At present, there is no NCD or national Medicare coverage policy that has been issued by CMS on this procedure. In the absence of a NCD or national coverage policy on a subject, however, local Medicare contractors have the discretion to cover the test whenever it is determined to be medically necessary for the individual patient.

December 9, 2005

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August 24, 2006