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


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.
Ong
Albert M
AM
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. aong@jhu.edu
Su
Li-Ming
LM
Varkarakis
Ioannis
I
Inagaki
Takeshi
T
Link
Richard E
RE
Bhayani
Sam B
SB
Patriciu
Alex
A
Crain
Barbara
B
Walsh
Patrick C
PC
D000818:Animals; D004285:Dogs; D004558:Electric Stimulation; D004598:Electrosurgery / Q000295:instrumentation; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D008297:Male; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000294:innervation*; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000503:physiopathology*; D011468:Prostatectomy / Q000295:instrumentation*; D012307:Risk Factors; D014464:Ultrasonic Therapy / Q000295:instrumentation