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Significance of electrostimulation in detecting neurovascular bundle during radical prostatectomy.
- Source :
-
International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2006 Jul; Vol. 13 (7), pp. 926-31. - Publication Year :
- 2006
-
Abstract
- Objective: The reported rate of erectile dysfunction after nerve-sparing prostatectomy varies according to physicians. Because exact preservation of the neurovascular bundle (NVB) solely depends on the judgment of the physician, he or she should try to correctly identify the NVB and also avoid neurophysiologic injury of the NVB during the procedure. The purpose of the present study is to assess the status of the NVB preservation by physician's judgment at the operation, the changes in intracavernous pressure related to intraoperative electrical stimulation and postoperative histopathological examination.<br />Patients and Methods: Thirty-eight patients who underwent nerve-sparing radical prostatectomy judged by intraoperative electrical stimulation of the NVB were included in this study. Bilateral, unilateral and non-nerve-sparing procedures were performed in 18, 17, and 3 cases, respectively. The NVB preservation evaluated by intraoperative physician's judgment was compared to that evaluated by postoperative histopathological examination. Furthermore, the NVB preservation evaluated by intraoperative electrical stimulation was compared to that by physician's judgment and postoperative histopathological examination.<br />Results: For 68 of 76 NVB (89.5%), intraoperative subjective judgment and histopathological assessment were identical. For 66 of 76 NVB (86.8%), electrical stimulation findings and the physician's judgments were identical, and for 70 of 76 NVB (92.1%), electrical stimulation findings and histopathological findings were identical.<br />Conclusion: Even if physicians are convinced of a successful nerve-sparing procedure, there are some cases in which the NVB is not preserved accurately or neurophysiological damage is suffered. Therefore, intraoperative electrical stimulation of the NVB as well as the cavernosal nerve is very useful in evaluation of NVB preservation.
- Subjects :
- Aged
Electric Stimulation methods
Follow-Up Studies
Humans
Intraoperative Complications prevention & control
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Blood Vessels physiopathology
Monitoring, Intraoperative methods
Nerve Fibers physiology
Prostate blood supply
Prostate innervation
Prostatectomy methods
Prostatic Diseases surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0919-8172
- Volume :
- 13
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- International journal of urology : official journal of the Japanese Urological Association
- Publication Type :
- Academic Journal
- Accession number :
- 16882057
- Full Text :
- https://doi.org/10.1111/j.1442-2042.2006.01442.x