title: Significance of electrostimulation in detecting neurovascular bundle during radical prostatectomy.
abstract: 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.
authors.affiliation: Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan. akitsuji@uro.med.osaka-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Tsujimura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyagawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Takao
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Matsumiya
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakayama
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Tsujimoto
authors.forename: Natsuki
authors.initials: N
authors.lastname: Takaha
authors.forename: Kazuo
authors.initials: K
authors.lastname: Nishimura
authors.forename: Norio
authors.initials: N
authors.lastname: Nonomura
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takada
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujioka
authors.forename: Kohei
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Aozasa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okuyama
mesh_terms: 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