Nerve sparing radical prostatectomy: Effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model

被引:1
作者
Ong, AM
Su, LM
Varkarakis, I
Inagaki, T
Link, RE
Bhayani, SB
Patricia, A
Crain, B
Walsh, PC
机构
[1] James Buchanan Brady Urol. Institute, Johns Hopkins Medical Institutions, Baltimore, MD
[2] Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
[3] James Buchanan Brady Urol. Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287
关键词
Dogs; Hemostasis; Penile erection; Prostate; Prostatectomy;
D O I
10.1016/S0022-5347(18)38313-7
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: To preserve sexual function following radical prostatectomy, one must avoid injury to the neurovascular bundles (NVBs). In the conventional open surgical technique, the use of energy sources for hemostasis is avoided to prevent damage to the cavernous nerves. In contrast, during laparoscopic radical prostatectomy, electrosurgical and ultrasonic energy sources are frequently used for hemostasis during dissection of the prostate. In this study, we evaluated the acute and chronic physiological effects of various hemostatic energy sources on cavernous nerve function in the canine model. Materials and Methods: A total of 12 dogs were divided into 4 groups based on the type of energy source used for hemostasis during unilateral dissection of the NVB. The groups included conventional dissection with suture ligatures (group 1), monopolar (group 2) or bipolar (group 3) electrosurgery and ultrasonic shears (group 4). The contralateral NVB was left undissected as a control. Erectile function was assessed acutely and after 2 weeks of survival by measuring peak intracavernous pressures in response to cavernous nerve stimulation. Results: Following conventional techniques of nerve sparing, the erectile response to nerve stimulation was unaffected. In contrast, the use of energy sources in proximity to the NVB during nerve preservation was associated with a substantial decrease in erectile response both acutely (74% to 91% decrease compared to controls) and after 2 weeks (93% to 96% decrease). Conclusions: In the chronic canine model, use of hemostatic energy sources in proximity to the prostate during dissection of the neurovascular bundle is associated with a significantly decreased erectile response to cavernous nerve stimulation.
引用
收藏
页码:284 / 284
页数:1
相关论文
共 20 条
[1]   Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies [J].
Catalona, WJ ;
Carvalhal, GF ;
Mager, DE ;
Smith, DS .
JOURNAL OF UROLOGY, 1999, 162 (02) :433-438
[2]   Laparoscopic radical prostatectomy: Initial 70 cases at a US university medical center [J].
Dahl, DM ;
L'esperance, JO ;
Trainer, AF ;
Jiang, Z ;
Gallagher, K ;
Litwin, DEM ;
Blute, RD .
UROLOGY, 2002, 60 (05) :859-863
[3]   Neuroprotection due to irrigation during bipolar cautery [J].
Donzelli, J ;
Leonetti, JP ;
Wurster, RD ;
Lee, JM ;
Young, MRI .
ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, 2000, 126 (02) :149-153
[4]  
Greenwood J Jr, 1942, Arch Phys Ther, V23, P552
[5]   Laparoscopic radical prostatectomy: assessment after 550 procedures [J].
Guillonneau, B ;
Cathelineau, X ;
Doublet, JD ;
Baumert, H ;
Vallancien, G .
CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2002, 43 (02) :123-133
[6]  
Guillonneau B, 2000, J UROLOGY, V163, P1643, DOI 10.1016/S0022-5347(05)67512-X
[7]   The effect of bipolar electrocautery on peripheral nerves [J].
Hnatuk, LA ;
Li, KT ;
Carvalho, AJ ;
Freeman, JL ;
Bilbao, JM ;
McKee, NH .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1998, 101 (07) :1867-1874
[8]   Patient reported sexual function following laparoscopic radical prostatectomy [J].
Katz, R ;
Salomon, L ;
Hoznek, A ;
de la Taille, A ;
Vordos, D ;
Cicco, A ;
Chopin, D ;
Abbou, CC .
JOURNAL OF UROLOGY, 2002, 168 (05) :2078-2082
[9]   Bilateral nerve grafting during radical retropubic prostatectomy: Extended follow-up [J].
Kim, ED ;
Nath, R ;
Slawin, KM ;
Kadmon, D ;
Miles, BJ ;
Scardino, PT .
UROLOGY, 2001, 58 (06) :983-987
[10]   Role of "Bovie" in spinal surgery - Historical and analytical perspective [J].
Kumar, K ;
Crawford, AH .
SPINE, 2002, 27 (09) :1000-1006