The cavernous nerves, originating from the pelvic plexus, form a neurovascular bundle with adjacent vessels, traversing between the prostatic capsule and ventral fascia. These nerves are critically involved in male erectile function and urinary control. Damage to the cavernous nerves, caused by pelvic fractures, radiation therapy, or radical prostatectomy (particularly for prostate cancer), often leads to erectile dysfunction (ED), significantly impairing patients' quality of life. Despite advancements in laparoscopic, robot-assisted, and nerve-sparing surgical techniques, challenges persist due to the nerves’ fine structure and interpatient anatomical variations. Current treatments for post-traumatic ED remain suboptimal. Various peripheral nerve imaging modalities, including ultrasound, magnetic resonance imaging (MRI), nerve-specific dyes, and optical technologies, have been explored to enhance cavernous nerve visualization. This review aims to summarize advancements in cavernous nerve imaging to mitigate intraoperative nerve injury and reduce ED incidence.

A literature search was conducted using PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang databases with keywords such as "cavernous nerves," "peripheral nerve imaging," "intraoperative imaging in radical prostatectomy," "ultrasound," and "nerve-specific dyes."

Advances in imaging technologies, including high-resolution ultrasound, MRI, nerve-specific dyes, and optical coherence tomography (OCT), have enabled improved visualization of cavernous nerves. However, limitations such as neurotoxicity, high costs, and insufficient spatial resolution hinder their clinical translation.

While cavernous nerve imaging techniques have evolved rapidly, demonstrating unique advantages and limitations, none have yet achieved routine clinical application. Given the high prevalence of ED secondary to cavernous nerve injury, further studies are required to identify optimal intraoperative imaging modalities for nerve preservation, ultimately reducing postoperative ED incidence.