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Stolzenburg JU, Franz T, Kallidonis P, Minh D, Dietel A, Hicks J, Nicolaus M, Al-Aown A, Liatsikos E. Comparison of the FreeHand® robotic camera holder with human assistants during endoscopic extraperitoneal radical prostatectomy. BJU Int 2010; 107:970-4. [PMID: 20973908 DOI: 10.1111/j.1464-410x.2010.09656.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE • To assess, in a prospective randomized study, the efficiency of the FreeHand® (Prosurgics Ltd, Bracknell, UK) compared to manual camera control during the performance of endoscopic extraperitoneal radical prostatectomy (EERPE). PATIENTS AND METHODS • Three surgeons performed 50 EERPE for localized prostate cancer. In group A (n= 25), procedures were performed with manual control of the camera by the assistant, whereas group B (n= 25) patients were treated with the assistance of the FreeHand® robotic device. • The EERPE procedure was divided into several steps. • Total operation duration, time for each surgical step, number of camera movements, number of movement errors, number of times the lens was cleaned, blood loss and margin status were compared. RESULTS • No statistically significant difference was observed in terms of patient age, preoperative prostate-specific antigen level, Gleason score, positive cores and prostate volume. • The average operation duration required for the performance of each step did not differ significantly between the two groups. • Significant differences in favour of the FreeHand® camera holder were observed in case of horizontal and zooming camera movement, camera cleaning and camera errors. • Vertical camera movements were performed significantly faster by the human assistant compared to the robotic camera holder. • The average total operation duration was similar for both groups. • Positive surgical margins were detected in one patient in each group (4% of the patients). CONCLUSIONS • A comparison of the FreeHand® robotic camera holder with human camera control during EERPE showed a similar time requirement for the performance of each step of the procedure. • The robotic system provided accurate and fast movements of the camera without compromising the outcome of the procedure.
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Stolzenburg JU, Kallidonis P, Minh D, Dietel A, Häfner T, Rabenalt R, Sakellaropoulos G, Ganzer R, Paasch U, Horn LC, Liatsikos E. A Comparison of Outcomes for Interfascial and Intrafascial Nerve-sparing Radical Prostatectomy. Urology 2010; 76:743-8. [DOI: 10.1016/j.urology.2010.03.089] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 01/24/2010] [Accepted: 03/05/2010] [Indexed: 11/24/2022]
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Xylinas E, Ploussard G, Salomon L, Paul A, Gillion N, Laet KD, Vordos D, Hoznek A, Abbou CC, de la Taille A. Intrafascial nerve-sparing radical prostatectomy with a laparoscopic robot-assisted extraperitoneal approach: early oncological and functional results. J Endourol 2010; 24:577-82. [PMID: 20136397 DOI: 10.1089/end.2009.0069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We investigated whether an intrafascial approach to prostatectomy would provide significantly improved outcomes compared with retropubic and laparoscopic approaches. We performed 50 radical prostatectomies with an intrafascial, nerve-sparing, laparoscopic, robot-assisted extraperitoneal approach. METHODS From December 2007 to June 2008, 50 consecutive patients underwent nerve sparing surgery using the intrafascial technique with robotic assistance. All surgeries were performed by the same senior urologist. Patient characteristics and perioperative data were collected prospectively. Oncological outcomes were assessed by pathological examination and postoperative prostate-specific antigen levels. Functional outcomes, including continence, potency, and quality of life, were assessed from patient questionnaires. RESULTS The mean operative time was 127 minutes (range: 80-205), the mean hospital stay was 4.2 days (range: 2-9), and the mean catheterization time was 7.8 days (range: 4-11). No perioperative complications occurred. One patient required a transfusion at the postoperative stage. The overall positive surgical margin rate was 12%; adjusted by tumor, nodes, and metastasis stage, it was 9.5% in pT2 and 17% in pT3 disease. At the 1-month follow-up, 66% of the patients were continent (no pad), 12% presented a minimal stress urinary incontinence (1 pad), and 22% required >1 pad(s) per day. Further, 60% of patients exhibited potency (erection sufficient for intercourse: 30% without the use of phosphodiesterase 5 inhibitors, 30% required a phosphodiesterase 5 inhibitor) and the remaining 40% required prostaglandin injections. CONCLUSIONS An intrafascial approach with robotic assistance provided satisfactory early functional results with respect to postoperative continence and potency. Long-term oncological results remain to be assessed.
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Stolzenburg JU, Do M, Kallidonis P, Ghulam N, Hellawell G, Haefner T, Liatsikos EN. Hemostasis During Nerve-Sparing Endoscopic Extraperitoneal Radical Prostatectomy. J Endourol 2010; 24:505-9. [DOI: 10.1089/end.2009.0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | - Nabi Ghulam
- Department of Urology, University of Aberdeen, Aberdeen, Scotland
| | - Giles Hellawell
- Department of Urology, Northwick Park Hospital, London, United Kingdom
| | - Tim Haefner
- Department of Urology, University of Leipzig, Leipzig, Germany
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[Laparoscopic radical prostatectomy: six key points of operative skill for achieving better urinary continence]. Nihon Hinyokika Gakkai Zasshi 2010; 101:1-12. [PMID: 20158072 DOI: 10.5980/jpnjurol.101.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Postoperative urinary incontinence is a major impairment to patients' quality of life after prostatectomy, and is not limited to laparoscopic total prostatectomy. Improvements in devices and techniques of laparoscopic surgery have facilitated reliable cancer control, and in this situation there will now be increasing focus on postoperative quality of life (QOL), particularly urinary incontinence. Between July 2007 and March 2009, we have performed laparoscopic total prostatectomy for 53 patients, focusing on techniques to reduce urinary incontinence. Here we report the details of six key points of operative skill for achieving better urinary continence. These include (1) minimal distal incision of the endopelvic fascia; (2) preservation of the bladder neck; (3) bilateral nerve-sparing surgery; (4) preservation of the puboprostatic ligament and its refixation to the anterior aspect of the bladder neck (bladder neck sling suspension); (5) preservation of the posterior (membranous) urethra; (6) suturing of the posterior aspect of the rhabdosphincter, the remaining portion of the Denonvilliers fascia, and the bladder neck (restoration of the Denonvilliers fascia). Moreover, we separated the 53 patients into two groups: those who were not treated using the above six key points, and those who were. We then compared the data for the two groups with regard to the time taken for continence recovery, operative parameters (operation time and bleeding), and postoperative pathological findings.
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Graefen M. The Modified Clavien System: A Plea for a Standardized Reporting System for Surgical Complications. Eur Urol 2010; 57:387-9. [DOI: 10.1016/j.eururo.2009.12.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 12/10/2009] [Indexed: 11/29/2022]
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Graefen M. Low quality of evidence for robot-assisted laparoscopic prostatectomy: a problem not only in the robotic literature. Eur Urol 2010; 57:938-40; discussion 943-4. [PMID: 20171006 DOI: 10.1016/j.eururo.2010.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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Greco F, Wagner S, Hoda MR, Kawan F, Inferrera A, Lupo A, Reichelt O, Jurczok A, Hamza A, Fornara P. Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients. BJU Int 2010; 106:543-7. [PMID: 20067455 DOI: 10.1111/j.1464-410x.2009.09157.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP). PATIENTS AND METHODS Between January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared. RESULTS The operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups. CONCLUSION Our study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.
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Affiliation(s)
- Francesco Greco
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany.
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Patil K, Kirby R, Hicks J, Stolzenburg JU. LAPAROSCOPY OR ROBOTICS: WHERE DOES THE FUTURE LIE? BJU Int 2009; 104:1551-3. [DOI: 10.1111/j.1464-410x.2009.08782.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Do M, Haefner T, Liatsikos E, Kallidonis P, Hicks J, Dietel A, Horn LC, Rabenalt R, Stolzenburg JU. Endoscopic extraperitoneal radical prostatectomy after previous transurethral resection of prostate: oncologic and functional outcomes of 100 cases. Urology 2009; 75:1348-52. [PMID: 19914701 DOI: 10.1016/j.urology.2009.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 07/27/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study radical prostatectomy that has been reported to be more challenging and associated with complications in patients with history of transurethral resection of prostate (TURP). METHODS In our series, 100 of 2300 patients had undergone endoscopic extraperitoneal radical prostatectomy (EERPE) after previous TURP. All patients included in the study had at least 1-year follow-up. Patient demographics, mean blood loss, mean catheterization time, complications, functional and oncologic outcome were reviewed. RESULTS In all, 100 patients underwent EERPE and 26 of these patients were treated by nerve-sparing EERPE. Lymphadenectomy was performed in 45 patients. Operative time and mean blood loss were similar to previous EERPE series. The transfusion rate and mean time of catheterization were slightly higher than general EERPE population. Positive surgical margin rates were 7% for pT2 and 36% for pT3/4. At 12-month follow-up, 94% of the patients did not experience prostate-specific antigen level>or=0.1 ng/mL. The overall complication rate was 14%. At 12 months, 93% of patients were continent, 4% used 1-2 pads/day and 3% needed >2 pads/day. The potency rates for the 26 patients who underwent nerve-sparing EERPE were 52.6% and 66.7% at 6 and 12 months, respectively. CONCLUSIONS Patients who had previously undergone TURP should be considered for radical treatment with EERPE. The procedure is safe even though technically more demanding. Perioperative, functional, and short-term oncologic outcome is promising and directly comparable to existing EERPE experience. Potency results were lower in comparison with existing EERPE series.
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Affiliation(s)
- Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
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Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, Menon M, Montorsi F, Myers RP, Rocco B, Villers A. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 2009; 57:179-92. [PMID: 19931974 DOI: 10.1016/j.eururo.2009.11.009] [Citation(s) in RCA: 304] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 11/02/2009] [Indexed: 01/20/2023]
Abstract
CONTEXT Detailed knowledge of the anatomy of the prostate and adjacent tissues is mandatory during radical prostatectomy to ensure reliable oncologic and functional outcomes. OBJECTIVE To review critically and to summarize the available literature on surgical anatomy of the prostate and adjacent structures involved in cancer control, erectile function, and urinary continence. EVIDENCE ACQUISITION A search of the PubMed database was performed using the keywords radical prostatectomy, anatomy, neurovascular bundle, fascia, pelvis, and sphincter. Relevant articles and textbook chapters were reviewed, analyzed, and summarized. EVIDENCE SYNTHESIS Anatomy of the prostate and the adjacent tissues varies substantially. The fascia surrounding the prostate is multilayered, sometimes either fused with the prostate capsule or clearly separated from the capsule as a reflection of interindividual variations. The neurovascular bundle (NVB) is situated between the fascial layers covering the prostate. The NVB is composed of numerous nerve fibers superimposed on a scaffold of veins, arteries, and variable amounts of adipose tissue surrounding almost the entire lateral and posterior surfaces of the prostate. The NVB is also in close, cage-like contact to the seminal vesicles. The external urethral sphincter is a complex structure in close anatomic and functional relationship to the pelvic floor, and its fragile innervation is in close association to the prostate apex. Finally, the shape and size of the prostate can significantly modify the anatomy of the NVB, the urethral sphincter, the dorsal vascular complex, and the pubovesical/puboprostatic ligaments. CONCLUSIONS The surgical anatomy of the prostate and adjacent tissues involved in radical prostatectomy is complex. Precise knowledge of all relevant anatomic structures facilitates surgical orientation and dissection during radical prostatectomy and ideally translates into both superior rates of cancer control and improved functional outcomes postoperatively.
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Affiliation(s)
- Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Center, 232, Bd Ste. Marguerite, 13009 Marseille, France.
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Extrafascial Versus Interfascial Nerve-sparing Technique for Robotic-assisted Laparoscopic Prostatectomy: Comparison of Functional Outcomes and Positive Surgical Margins Characteristics. Urology 2009; 74:611-6. [DOI: 10.1016/j.urology.2009.01.092] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 01/19/2009] [Accepted: 01/29/2009] [Indexed: 11/21/2022]
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Stolzenburg JU, Kallidonis P, Minh D, Dietel A, Häfner T, Dimitriou D, Al-Aown A, Kyriazis I, Liatsikos EN. Endoscopic Extraperitoneal Radical Prostatectomy: Evolution of the Technique and Experience with 2400 Cases. J Endourol 2009; 23:1467-72. [DOI: 10.1089/end.2009.0336] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | - Do Minh
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Tim Häfner
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Evangelos N. Liatsikos
- Department of Urology, University of Leipzig, Leipzig, Germany
- Department of Urology, University of Patras, Patras, Greece
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66
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Current Technique of Open Intrafascial Nerve-Sparing Retropubic Prostatectomy. Eur Urol 2009; 56:317-24. [DOI: 10.1016/j.eururo.2009.05.044] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 05/05/2009] [Indexed: 11/22/2022]
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Schwalenberg T, Neuhaus J, Liatsikos E, Winkler M, Löffler S, Stolzenburg JU. Neuroanatomy of the male pelvis in respect to radical prostatectomy including three-dimensional visualization. BJU Int 2009; 105:21-7. [PMID: 19549118 DOI: 10.1111/j.1464-410x.2009.08702.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The neuroanatomical structures of the radical prostatectomy (RP) are extensively discussed for their existence, localization and function. Especially structures, e.g. the so-called neurovascular bundle (NVB) that are points of debate in numerous anatomical studies. We review the literature and present our observations in cadaveric specimens, to reconstruct neuroanatomical structures in three dimensions (3D) with the use of appropriate computer applications and produce images of operative fields. We used an internet PubMed survey (http://www.ncbi.nlm.nih.gov) to review recent publications and included back copies of historical neuroanatomical studies from our own library. Our own experimental cadaveric (specimens preserved in Thiel's solution) studies of the autonomic nerve supply of the lower urinary tract were also reviewed. Visualization of the pelvic anatomy and neuroanatomy was done using computer-based software packages. No unified terminology for the structures of the NVBs can be presented to date. The innervation of the smooth muscular structures of the urethra and the complex morphology of urethral sphincter remain unclear. Our cadaveric studies showed that nerves are located on the lateral aspect of the prostate in addition to the NVBs described at the dorsolateral side of the prostate. The neuroanatomical investigations of the male pelvis and visualization of the structures in 3D enable the presentation of operative sites as seen intraoperatively. Moreover, dynamic depiction of the pelvic floor is also possible.
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van der Poel H, de Blok W. Role of Extent of Fascia Preservation and Erectile Function After Robot-assisted Laparoscopic Prostatectomy. Urology 2009; 73:816-21. [DOI: 10.1016/j.urology.2008.09.082] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/28/2008] [Accepted: 09/20/2008] [Indexed: 01/14/2023]
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Sievert KD, Hennenlotter J, Laible IA, Amend B, Nagele U, Stenzl A. The Commonly Performed Nerve Sparing Total Prostatectomy Does Not Acknowledge the Actual Nerve Courses. J Urol 2009; 181:1076-81. [DOI: 10.1016/j.juro.2008.10.154] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Ines A. Laible
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - Bastian Amend
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - Udo Nagele
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tuebingen, Tuebingen, Germany
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Naspro R. Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status. Eur Urol 2009; 55:1384-5. [PMID: 19243885 DOI: 10.1016/j.eururo.2009.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ramírez Backhaus M, José Ruiz-Cerdá L, Juan Cruz Jiménez F, Uwe Stolzenburg J, Do M, Dietel A. El aprendizaje de la Prostatectomía Radical Laparoscópica según el modelo de Leipzig. Análisis de un programa tutelado progresivo. Actas Urol Esp 2009; 33:290-5. [DOI: 10.1016/s0210-4806(09)74143-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gallina A, Salonia A, Briganti A, Suardi N, Dehò F, Zanni G, Saccà A, Abdollah F, Cestari A, Guazzoni G, Rigatti P, Montorsi F. Prevention and Management of Postprostatectomy Erectile Dysfunction. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eursup.2008.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Value of frozen section biopsies during radical prostatectomy: significance of the histological results. World J Urol 2008; 27:227-34. [PMID: 19082603 DOI: 10.1007/s00345-008-0360-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To review the evidence about frozen sections during radical prostatectomy (RP) and its ability to decrease the incidence of positive margins, the impact on PSA postoperatively and the significance of residual benign prostatic cells after prostatectomy. METHODS The information for this review was compiled by searching the Pubmed database. We used Mesh Terms "Prostatectomy" and "Prostatic Neoplasms" and we added "frozen sections" and/or "hyperplasic cells" and/or "benign cells" and/or "positive margins". Furthermore, we review the articles referenced in those studies and editorials letters. RESULTS Several groups have studied the performance of frozen section during RP to try and assess the risk of positive margins intraoperatively. The controversial sites where they should be performed are the apex, the dorsolateral zones and the bladder neck. They have been performed routinely or when the surgeon decides it, depending on the preoperative or intraoperative findings. CONCLUSIONS At the present time there is no standardisation in the number, the site and the type of patient where this procedure should be done. The improvement in functional outcomes and biochemical control is not proven.
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Nerves at the ventral prostatic capsule contribute to erectile function: initial electrophysiological assessment in humans. Eur Urol 2008; 55:148-54. [PMID: 18835086 DOI: 10.1016/j.eururo.2008.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 09/16/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent microanatomical studies have identified a significant amount of nerve fibers along the ventral circumference of the prostate capsule and confirmed the concept of a periprostatic nerve network. However, functional investigations have not yet proved whether nerve fibers distributed on the prostate capsule, particularly those outside the neurovascular bundle (NVB), contribute to erection. OBJECTIVE To confirm whether nerve fibers distributed on the prostate capsule contribute to erectile function, the present study was performed using electrophysiologic testing. DESIGN, SETTING, AND PARTICIPANTS The circumference of the prostate capsule was electrically stimulated during radical retropubic prostatectomy (RRP) in 12 patients with clinically localized prostate cancer (PCa). We defined the ventromedian circumference of the prostate capsule as the 12 o'clock position and the posterolateral position of the typical NVB as the 5 o'clock position. Periprostatic nerve fibers at the 12, 1, 2, 3, 4, and 5 o'clock positions of the midprostate were stimulated using bipolar electrodes. MEASUREMENTS Changes in pressure at the middle of the urethra were measured using an inserted balloon catheter to detect increases in cavernosal pressure. RESULTS AND LIMITATIONS Although the study included only 12 patients, every stimulation at all positions between 1 and 5 o'clock evoked urethral pressure responses in all patients. Mean pressure response was most powerful for 5 o'clock stimulation and decreased with stimulated points further from the 5 o'clock position. CONCLUSIONS We demonstrated that electrostimulation at not only the posterolateral but also the anterior and lateral circumference of the prostate capsule can increase cavernosal pressure. These findings indicate that the periprostatic nerve network contributes to erections.
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Radical Prostatectomy in 2007: Oncologic Control and Preservation of Functional Integrity. Eur Urol 2008; 53:877-9. [DOI: 10.1016/j.eururo.2007.12.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/17/2007] [Indexed: 11/23/2022]
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