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EVIDENCE OF TRIGONAL DENERVATION AND REINNERVATION AFTER RADICAL RETROPUBIC PROSTATECTOMY

2001; Lippincott Williams & Wilkins; Volume: 165; Issue: 1 Linguagem: Inglês

10.1097/00005392-200101000-00028

1527-3792

Hubert John, D. Hauri, MÉLANIE LEUENER, M. Reinecke, Caroline Maake,

Pelvic floor disorders treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2001EVIDENCE OF TRIGONAL DENERVATION AND REINNERVATION AFTER RADICAL RETROPUBIC PROSTATECTOMY HUBERT JOHN, DIETER HAURI, MÉLANIE LEUENER, MANFRED REINECKE, and CAROLINE MAAKE HUBERT JOHNHUBERT JOHN More articles by this author , DIETER HAURIDIETER HAURI More articles by this author , MÉLANIE LEUENERMÉLANIE LEUENER More articles by this author , MANFRED REINECKEMANFRED REINECKE More articles by this author , and CAROLINE MAAKECAROLINE MAAKE More articles by this author View All Author Informationhttps://doi.org/10.1097/00005392-200101000-00028AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Urinary incontinence continues to be a major consequence of radical prostatectomy. To understand the pathophysiology of this dysfunction we studied the impact of autonomic innervation of the superficial trigone on postoperative urinary continence. Materials and Methods: To investigate nerve fiber density biopsies of the superficial trigone were obtained in 34 patients preoperatively as well as 6 weeks and 6 months postoperatively in 15 and 19, respectively. Specimens were Bouin fixed, paraffin embedded and processed for light microscopic immunohistochemical evaluation using an antibody against protein gene product 9.5, a general neuronal marker protein. In parallel we performed a comprehensive urodynamic evaluation, including determination of maximal urethral closure pressure and posterior urethral sensory threshold. Results: Postoperatively protein gene product 9.5 immunoreactive nerve fiber density was generally decreased. However, nerve fiber density after 6 weeks of incontinence in 12 of 15 patients was only 7%, while 3 of 15 who were continent preserved 36% of initial nerve fiber density. After 6 months nerve fiber density in 19 patients increased in 3 with incontinence to 20% and in 16 with continence to 44% of intraoperative density. Urinary incontinence was associated with decreased trigonal innervation, a high sensory threshold and low maximal urethral closure pressure. Conclusions: Protein gene product 9.5 immunoreactive nerve fiber density corresponds with posterior urethral sensory threshold and urinary continence. Thus, preserving trigonal innervation and postoperative reinnervation may be important factors for achieving early postoperative urinary continence after radical prostatectomy. References 1 : Effect of radical prostatectomy on sensory threshold and pressure transmission. J Urol2000; 163: 1761. 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Urol Clin North Am1996; 23: 177. Google Scholar From the Clinic of Urology, Zürich University Hospital and Institute of Anatomy, Zürich University, Zürich, Switzerland© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byTeber D, Sofikerim M, Ates M, Gözen A, Güven O, Sanli Ö and Rassweiler J (2010) Is Type 2 Diabetes Mellitus a Predictive Factor for Incontinence After Laparoscopic Radical Prostatectomy? A Matched Pair and Multivariate AnalysisJournal of Urology, VOL. 183, NO. 3, (1087-1091), Online publication date: 1-Mar-2010.Catarin M, Manzano G, Nóbrega J, Almeida F, Srougi M and Bruschini H (2008) The Role of Membranous Urethral Afferent Autonomic Innervation in the Continence Mechanism After Nerve Sparing Radical Prostatectomy: A Clinical and Prospective StudyJournal of Urology, VOL. 180, NO. 6, (2527-2531), Online publication date: 1-Dec-2008.GOMHA M and BOONE T (2018) Voiding Patterns In Patients With Post-Prostatectomy Incontinence: Urodynamic And Demographic AnalysisJournal of Urology, VOL. 169, NO. 5, (1766-1769), Online publication date: 1-May-2003.John H and Hauri D (2018) RE: NERVE AND SEMINAL SPARING RADICAL CYSTECTOMY WITH ORTHOTOPIC URINARY DIVERSION FOR SELECT PATIENTS WITH SUPERFICIAL BLADDER CANCER: AN INNOVATIVE SURGICAL APPROACHJournal of Urology, VOL. 166, NO. 4, (1402-1402), Online publication date: 1-Oct-2001. Volume 165Issue 1January 2001Page: 111-113 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordshypogastric plexusprostateurinary incontinenceprostatectomyMetricsAuthor Information HUBERT JOHN More articles by this author DIETER HAURI More articles by this author MÉLANIE LEUENER More articles by this author MANFRED REINECKE More articles by this author CAROLINE MAAKE More articles by this author Expand All Advertisement PDF downloadLoading ...