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Alanazi G, Alsubaie N, Nabi G, Gillingwater TH, Alashkham A. Distribution of neurovascular structures within the prostate gland and their relationship to complications after radical prostatectomy. Prostate 2024; 84:491-501. [PMID: 38173273 DOI: 10.1002/pros.24667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Radical prostatectomy remains the main choice of treatment for prostate cancer. However, despite improvements in surgical techniques and neurovascular sparing procedures, rates of erectile dysfunction, and urinary incontinence remain variable. This is due, at least in part, to an incomplete understanding of neurovascular structures associated with the prostate. The objective of this study was to provide a comprehensive, detailed histological overview of the distribution of nerves and blood vessels within the prostate, facilitating subsequent correlation of prostatic neurovascular structures with patients' clinical outcomes after radical prostatectomy. METHODS Neurovascular structures within the prostate were investigated in a total of 309 slides obtained from 15 patients who underwent non-nerve-sparing radical prostatectomy. Immunohistochemical staining was performed to identify and distinguish between parasympathetic and sympathetic nerves, whereas hematoxylin and eosin staining was used to identify blood vessels. The total number, density, and relative position of nerves and blood vessels were established using quantitative morphometry and illustrated using visualization approaches. Patient-specific outcome data were then used to establish whether the internal distribution of nerves and blood vessels within the prostate correlated with the nature and extent of complications after surgery. One-way analysis of variance tests and unpaired t tests were applied to establish statistically significant differences across the measured variables. RESULTS Nerves and blood vessels were present across all prostatic levels and regions. However, their number and density varied considerably between regions. Assessment of the precise positioning of neurovascular structures revealed that the majority of nerve fibers were located within the dorsal and peripheral aspects of the gland. In contrast, blood vessels were predominantly located within ventral and dorsal midline regions. The number of intraprostatic nerves was found to be significantly lower in patients who recovered their continence within 12 months of surgery, compared to those whose recovery took 12 months or longer. CONCLUSION We report an unexpected disconnect between the localization and positioning of nerve fibers and blood vessels within the prostate. Moreover, individual variability in the density of intraprostatic neurovascular structures appears to correlate with the successful recovery of urinary continence after radical prostatectomy, suggesting that differences in intrinsic neurovascular arrangements of the prostate influence postoperative outcomes.
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Affiliation(s)
- Ghazi Alanazi
- Anatomy, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Kingdom of Saudi Arabia
| | - Najah Alsubaie
- Department of Computer Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Ghulam Nabi
- Division of Cancer Research, University of Dundee, Dundee, UK
| | - Thomas H Gillingwater
- Anatomy, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
| | - Abduelmenem Alashkham
- Anatomy, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Seo HS, Shim JH, Jeon HM, Park CH, Song KY. Postoperative pancreatic fistula after robot distal gastrectomy. J Surg Res 2014; 194:361-366. [PMID: 25454974 DOI: 10.1016/j.jss.2014.10.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/09/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND To compare the incidences of postoperative pancreatic fistula (POPF) between robot-assisted distal gastrectomy (RADG) and laparoscopy-assisted distal gastrectomy (LADG). MATERIALS AND METHODS A total of 40 patients with gastric cancer who underwent RADG were compared with 40 initial patients who underwent LADG by a single surgeon. We evaluated and compared the clinicopathologic characteristics, surgical outcomes, and operative complications including POPF in two groups. RESULTS The POPF was observed more frequently in the LADG group than in the RADG group (22.5% versus 10%, P < 0.001). Although the serum amylase levels in the 20 first-half cases did not statistically differ between LADG and RADG (P = 0.32), those in the 20 latter-half cases were significantly lower in the RADG group (P < 0.05). Univariate and multivariate analyses identified laparoscopic surgery and visceral fat area as POPF-associated risk factors. CONCLUSIONS RADG is feasible and safe for distal gastrectomy in terms of POPF.
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Affiliation(s)
- Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Ho Shim
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Myung Jeon
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Shim JH, Kim JG, Jeon HM, Park CH, Song KY. The Robotic Third Arm as a Competent Analog of an Assisting Surgeon in Radical Gastrectomy: Impact on Short-Term Clinical Outcomes. J Laparoendosc Adv Surg Tech A 2013; 23:447-51. [DOI: 10.1089/lap.2012.0423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Jung Ho Shim
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Gi Kim
- Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hae Myung Jeon
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital, Seoul, Korea
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Magheli A, Burnett AL. Erectile dysfunction following prostatectomy: prevention and treatment. Nat Rev Urol 2009; 6:415-27. [PMID: 19657376 DOI: 10.1038/nrurol.2009.126] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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White WM, Kim ED. Interposition nerve grafting during radical prostatectomy: cumulative review and critical appraisal of literature. Urology 2009; 74:245-50. [PMID: 19428071 DOI: 10.1016/j.urology.2008.12.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/15/2008] [Accepted: 12/20/2008] [Indexed: 11/25/2022]
Abstract
In 1997, the first report of sural nerve interposition grafting during radical prostatectomy was published in Urology. The favorable findings in this initial pilot study generated numerous follow-up reports that have demonstrated conflicting and contradictory outcomes. Certainly, controversy exists regarding the true benefit of nerve grafting. This review will objectively and critically summarize the salient literature, discuss evolving techniques, and offer insight into the future of interposition grafting in the current era of clinically localized prostate cancer and robotic prostatectomy.
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Affiliation(s)
- Wesley M White
- Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio 44195, USA.
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Riesz P, Rusz A, Szucs M, Majoros A, Nyírády P, Keszthelyi A, Szucs M, Mavrogenis S, Filkor G, Pánovics J, Romics I. [Prevention and treatment of erectile dysfunction after radical prostatectomy]. Orv Hetil 2009; 150:831-7. [PMID: 19383574 DOI: 10.1556/oh.2009.28569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.
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Affiliation(s)
- Péter Riesz
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Urológiai Klinika, Budapest Ulloi út 78/B, 1082.
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Latif MJ, Afthinos JN, Connery CP, Perin N, Bhora FY, Chwajol M, Todd GJ, Belsley SJ. Robotic intercostal nerve graft for reversal of thoracic sympathectomy: a large animal feasibility model. Int J Med Robot 2008; 4:258-62. [DOI: 10.1002/rcs.205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zorn KC, Bernstein AJ, Gofrit ON, Shikanov SA, Mikhail AA, Song DH, Zagaja GP, Shalhav AL. Long-Term Functional and Oncological Outcomes of Patients Undergoing Sural Nerve Interposition Grafting during Robot-Assisted Laparoscopic Radical Prostatectomy. J Endourol 2008; 22:1005-12. [DOI: 10.1089/end.2007.0381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kevin C. Zorn
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Andrew J. Bernstein
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Ofer N. Gofrit
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Sergey A. Shikanov
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Albert A. Mikhail
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - David H. Song
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Gregory P. Zagaja
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Arieh L. Shalhav
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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