Significance of electrostimulation in detecting neurovascular bundle during radical prostatectomy.
OBJECTIVE
The reported rate of erectile dysfunction after nerve-sparing prostatectomy varies according to physicians. Because exact preservation of the neurovascular bundle (NVB) solely depends on the judgment of the physician, he or she should try to correctly identify the NVB and also avoid neurophysiologic injury of the NVB during the procedure. The purpose of the present study is to assess the status of the NVB preservation by physician's judgment at the operation, the changes in intracavernous pressure related to intraoperative electrical stimulation and postoperative histopathological examination.


METHODS
Thirty-eight patients who underwent nerve-sparing radical prostatectomy judged by intraoperative electrical stimulation of the NVB were included in this study. Bilateral, unilateral and non-nerve-sparing procedures were performed in 18, 17, and 3 cases, respectively. The NVB preservation evaluated by intraoperative physician's judgment was compared to that evaluated by postoperative histopathological examination. Furthermore, the NVB preservation evaluated by intraoperative electrical stimulation was compared to that by physician's judgment and postoperative histopathological examination.


RESULTS
For 68 of 76 NVB (89.5%), intraoperative subjective judgment and histopathological assessment were identical. For 66 of 76 NVB (86.8%), electrical stimulation findings and the physician's judgments were identical, and for 70 of 76 NVB (92.1%), electrical stimulation findings and histopathological findings were identical.


CONCLUSIONS
Even if physicians are convinced of a successful nerve-sparing procedure, there are some cases in which the NVB is not preserved accurately or neurophysiological damage is suffered. Therefore, intraoperative electrical stimulation of the NVB as well as the cavernosal nerve is very useful in evaluation of NVB preservation.
Tsujimura
Akira
A
Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan. akitsuji@uro.med.osaka-u.ac.jp
Miyagawa
Yasushi
Y
Takao
Tetsuya
T
Matsumiya
Kiyomi
K
Nakayama
Masashi
M
Tsujimoto
Yuichiro
Y
Takaha
Natsuki
N
Nishimura
Kazuo
K
Nonomura
Norio
N
Takada
Tsuyoshi
T
Fujioka
Hideki
H
Kurokawa
Kohei
K
Aozasa
Katsuyuki
K
Okuyama
Akihiko
A
D000368:Aged; D001808:Blood Vessels / Q000503:physiopathology*; D004558:Electric Stimulation / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009412:Nerve Fibers / Q000502:physiology*; D011467:Prostate / Q000098:blood supply* / Q000294:innervation*; D011468:Prostatectomy / Q000379:methods*; D011469:Prostatic Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome