Portal de Periódicos da CAPES

NERVE SPARING RADICAL PROSTATECTOMY: EFFECTS OF HEMOSTATIC ENERGY SOURCES ON THE RECOVERY OF CAVERNOUS NERVE FUNCTION IN A CANINE MODEL

2004; Lippincott Williams & Wilkins; Volume: 172; Issue: 4 Part 1 Linguagem: Inglês

10.1097/01.ju.0000139883.08934.86

1527-3792

Albert M. Ong, Li-Ming Su, Ioannis Varkarakis, Takeshi Inagaki, Richard E. Link, Sam B. Bhayani, Alex Patriciu, Barbara J. Crain, Patrick C. Walsh,

Anesthesia and Pain Management

No AccessJournal of UrologyAdult Urology: Oncology: Prostate/Testis/Penis/Urethra1 Oct 2004NERVE SPARING RADICAL PROSTATECTOMY: EFFECTS OF HEMOSTATIC ENERGY SOURCES ON THE RECOVERY OF CAVERNOUS NERVE FUNCTION IN A CANINE MODEL ALBERT M. ONG, LI-MING SU, IOANNIS VARKARAKIS, TAKESHI INAGAKI, RICHARD E. LINK, SAM B. BHAYANI, ALEX PATRICIU, BARBARA CRAIN, and PATRICK C. WALSH ALBERT M. ONGALBERT M. ONG , LI-MING SULI-MING SU , IOANNIS VARKARAKISIOANNIS VARKARAKIS , TAKESHI INAGAKITAKESHI INAGAKI , RICHARD E. LINKRICHARD E. LINK , SAM B. BHAYANISAM B. BHAYANI , ALEX PATRICIUALEX PATRICIU , BARBARA CRAINBARBARA CRAIN , and PATRICK C. WALSHPATRICK C. WALSH View All Author Informationhttps://doi.org/10.1097/01.ju.0000139883.08934.86AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 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. Materials and 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. References 1 : Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol1999; 162: 433. Link, Google Scholar 2 : Factors predicting recovery of erections after radical prostatectomy. J Urol2000; 164: 1929. Link, Google Scholar 3 : Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology2000; 55: 58. Google Scholar 4 : Anatomic radical retropubic prostatectomy. In: . Philadelphia: W. B. Saunders Co.2002: 3107. sect. XI, chapt. 90. Google Scholar 5 : Laparoscopic radical prostatectomy: initial short-term experience. Urology1997; 50: 854. Crossref, Medline, Google Scholar 6 : Laparoscopic radical prostatectomy: the Montsouris technique. J Urol2000; 163: 1643. Link, Google Scholar 7 : Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center. Urology2002; 60: 859. Google Scholar 8 Su, L., Link, R. E., Bhayani, S. B. and Pavlovich, C. P.: Nerve sparing laparoscopic radical prostatectomy: techniques to aid in the neurovascular bundle dissection. Presented at the World Congress on Endourology and Shockwave, Montreal, Canada, September 2003 Google Scholar 9 : Electrosurgery in otolaryngology-head and neck surgery: principles, advances, and complications. Laryngoscope2001; 111: 769. Google Scholar 10 : Neuroprotection due to irrigation during bipolar cautery. Arch Otolaryngol Head Neck Surg2000; 126: 149. Google Scholar 11 : Role of "Bovie" in spinal surgery: historical and analytical perspective. Spine2002; 27: 1000. Google Scholar 12 : Potential preservation of potency after radical prostatectomy. Urology1983; 22: 165. Google Scholar 13 : The effect of bipolar electrocautery on peripheral nerves. Plast Reconstr Surg1998; 101: 1867. Google Scholar 14 : Two point coagulation: a follow-up report of a new technic and instrument for electrocoagulation in neurosurgery. Arch Phys Ther1942; 23: 552. Google Scholar 15 : The ultrasonic coagulating and cutting system injuries nerve function. Endoscopy2002; 34: 575. Google Scholar 16 : Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol2002; 43: 123. Google Scholar 17 : Patient reported sexual function following laparoscopic radical prostatectomy. J Urol2002; 168: 2078. Link, Google Scholar 18 : Vattikuti Institute prostatectomy: surgical technique and current results. Curr Urol Rep2003; 4: 119. Google Scholar 19 : Cavernous nerve grafts restore erectile function in denervated rats. J Urol1991; 145: 380. Link, Google Scholar 20 : Bilateral nerve grafting during radical retropubic prostatectomy: extended follow-up. Urology2001; 58: 983. Google Scholar From the James Buchanan Brady Urological Institute and Department of Pathology (BC), Johns Hopkins Medical Institutions, Baltimore, Maryland© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byGianduzzo T, Colombo J, Haber G, Magi-Galluzzi C, Dall'Oglio M, Ulchaker J and Gill I (2009) KTP Laser Nerve Sparing Radical Prostatectomy: Comparison of Ultrasonic and Cold Scissor Dissection on Cavernous Nerve FunctionJournal of Urology, VOL. 181, NO. 6, (2760-2766), Online publication date: 1-Jun-2009.Gianduzzo T, Colombo J, El-Gabry E, Haber G and Gill I (2008) Anatomical and Electrophysiological Assessment of the Canine Periprostatic Neurovascular Anatomy: Perspectives as a Nerve Sparing Radical Prostatectomy ModelJournal of Urology, VOL. 179, NO. 5, (2025-2029), Online publication date: 1-May-2008. Volume 172Issue 4 Part 1October 2004Page: 1318-1322 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsdogshemostasispenile erectionprostateprostatectomyMetricsAuthor Information ALBERT M. ONG More articles by this author LI-MING SU More articles by this author IOANNIS VARKARAKIS More articles by this author TAKESHI INAGAKI More articles by this author RICHARD E. LINK More articles by this author SAM B. BHAYANI More articles by this author ALEX PATRICIU More articles by this author BARBARA CRAIN More articles by this author PATRICK C. WALSH More articles by this author Expand All Advertisement PDF downloadLoading ...