Preliminary results of a monitoring system to confirm the preservation of cavernous nerves.
BACKGROUND
It is important to preserve the neurovascular bundle (NVB) during nerve-sparing surgery. This article presents the preliminary results of our monitoring system for the postoperative preservation of erectile function.


METHODS
In 15 patients undergoing radical prostatectomy and 20 patients undergoing radical cystoprostatectomy, intraoperative electrical stimulation along the NVB was performed to measure changes in intracavernous pressure before and after prostate removal. Seven of the radical prostatectomy patients and eight of the radical cystoprostatectomy patients underwent nerve-sparing surgery. Postoperative erectile function was evaluated in 25 patients not receiving adjuvant hormonal therapy.


RESULTS
The NVB was judged to be preserved at least on one side electrophysiologically in 14 of 15 patients. Pathologically, three patients had pT3 cancer. Postoperatively, sufficient erectile function was demonstrated using the International Index of Erectile Function 5 in three patients, nocturnal penile tumescence in three patients, and a questionnaire or an interview in three patients. The other patients were incompletely erectile. None of the 11 patients not receiving adjuvant hormonal therapy, in whom NVB was not preserved, were erectile.


CONCLUSIONS
If the successful criterion of nerve-sparing surgery is defined as a change in intracavernous pressure of 4 cm H2O or more being observed at least unilaterally, and the successful criteria of erectile function preservation includes being sufficiently erectile as revealed by an interview, the sensitivity of our system was 69.2% (9/13) and the specificity was 100% (12/12). Neither adverse reactions to the measurement, nor inadequacy of cancer excision accompanying NVB sparing, were observed. These results suggest that our system can predict postoperative erectile function fairly accurately.
Kurokawa
Kohei
K
Departments of Urology and Anesthesiology, Gunma University School of Medicine, Maebashi, Department of Urology, Gunma Cancer Center, Ota and Department of Urology Kurashiki Central Hospital, Kurashiki, Japan. kohei@showa.gunma-u.ac.jp
Suzuki
Takanori
T
SuzukI
Kazuhiro
K
Terada
Naoki
N
Ito
Kazuto
K
Yoshikawa
Daisuke
D
Arai
Yoichi
Y
Yamanaka
Hidetoshi
H
D000368:Aged; D015653:Cystectomy / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods; D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000294:innervation*; D017933:Peripheral Nervous System / Q000502:physiology*; D011183:Postoperative Complications; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery