title: Risk of Damage to the Somatic Innervation of the Penis during the AdVanceProcedure: An Anatomical Study.
abstract: BACKGROUND
  One of the methods to treat post radical prostatectomy stress urinary incontinence is the AdVance (American Medical Systems, Minnetonka, MN, USA) male sling procedure. During this procedure, the somatic innervation of the penis may be at risk for injury. Six AdVance procedures were performed in six donated bodies at the Anatomy and Embryology Department of the Leiden University Medical Centre. The pelves were dissected and the shortest distance between the sling and the dorsal nerve of the penis (DNP) was documented.
  
  
  OBJECTIVE
  The aim of this study was to describe the anatomical relation between the AdVance male sling and penile nerves based on the dissection of six adult male pelves.
  
  
  METHODS
  The AdVance male sling procedure was conducted in six donated male bodies. After placement, the pelves were dissected and the shortest distance between sling and the DNP was documented.
  
  
  METHODS
  The main outcome measure was the distance between the AdVance male sling and the DNP.
  
  
  RESULTS
  The mean distance of the sling to the DNP was 4.1 mm and was found situated directly next to the nerve (distance 0 mm) in 4 out of 12 (33%) hemipelves. The distance of the sling to the obturator neurovascular bundle was 30 mm or more in all six bodies.
  
  
  CONCLUSIONS
  Damage to the DNP caused by the AdVance male sling procedure appears to be an extremely rare complication, which has not been described in current literature. The proximity of the AdVance to the DNP could, however, pose a risk that should be taken into consideration by physicians and patients when opting for surgery.
authors.affiliation: Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Cornelis R C
authors.initials: CR
authors.lastname: Hogewoning
authors.affiliation: Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Henk W
authors.initials: HW
authors.lastname: Elzevier
authors.affiliation: Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rob C M
authors.initials: RC
authors.lastname: Pelger
authors.affiliation: Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Milou D
authors.initials: MD
authors.lastname: Bekker
authors.affiliation: Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marco C
authors.initials: MC
authors.lastname: DeRuiter
mesh_terms: D000328:Adult; D002102:Cadaver; D007172:Erectile Dysfunction / Q000601:surgery; D006801:Humans; D008297:Male; D010413:Penis / Q000033:anatomy & histology* / Q000294:innervation / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*; D060525:Pudendal Nerve / Q000033:anatomy & histology*; D012306:Risk; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery
keywords: AdVance™ Male Sling; Dorsal Nerve of Penis; Neuro-Anatomy; Radical Prostatectomy; Sling Surgery; Somatic Innervation; Stress Urinary Incontinence