Early Release of the Neurovascular Bundles and Optical Loupe Magnification Lead to Improved and Earlier Return of Potency Following Radical Retropubic Prostatectomy

Chuang, Marc S.; O’Connor, R. Corey; Laven, Brett A.; Orvieto, Marcelo A.; Brendler, Charles B.

doi:10.1097/01.ju.0000148941.57203.ec

Cited by 30 publications

(18 citation statements)

References 11 publications

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“…The observed continuously decreasing incidence of rectal injuries over the years probably reflects not only increased surgeon experience but also the use of loupes and xenon head lights. This matches recently published experience from other centers [17] .…”

Section: Discussionsupporting

confidence: 80%

Intraoperative and Early Postoperative Complications of Radical Retropubic Prostatectomy

Klevecka

Burmester²,

Musch³

et al. 2007

Urol Int

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Introduction: To determine the perioperative complications and morbidity of radical retropubic prostatectomy (RRP) and to analyze risk factors for observed complications. Materials and Methods: Data of 1,000 patients undergoing RRP and pelvic lymphadenectomy (pLA) performed by different surgeons of the same hospital were collected. Uni- and multivariate analysis was performed to detect associations between intra- and postoperative complications and specific variables. Results: Relevant intraoperative complications were observed in 28 cases and relevant postoperative complications in 187 cases requiring reoperations in 46 patients. Diverse minor postoperative complications occurred in 75 cases. The surgeon’s experience and the operating time significantly influenced the incidence of intraoperative complications. Extended pLA was associated with significantly higher rates of lymphoceles and reoperations. The patients with lymphocele showed significantly higher rates of deep venous thrombosis (DVT), pulmonary embolism (PE) and reoperation and patients with DVT a higher incidence of PE and a higher rate of reoperations. The incidence of anastomotic strictures correlated significantly with postoperative urine retention. Conclusions: RRP is a safe surgical procedure. In the hands of experienced urologic surgeons it is associated with lower incidences of severe intraoperative complications. A substantial proportion of postoperative complications are associated with pLA and its extension.

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Section: Discussionsupporting

confidence: 80%

Intraoperative and Early Postoperative Complications of Radical Retropubic Prostatectomy

Klevecka

Burmester²,

Musch³

et al. 2007

Urol Int

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show abstract

“…Therefore, gentle and meticulous preservation, such as an early release of the NVB, is essential [76,77]. This approach has been previously reported to provide better functional recovery, raising the possibility of traction injury and/or poor visualization [76]. Moreover, our study showed that more nNOS-positive nerve fibers spread over the NVB to the 5-6 o'clock region in ED patients than in non-ED patients [75].…”

Section: Existing Clinical Features and Cn Distributionsupporting

confidence: 46%

“…In our study, the fibers increased at the apex and are possibly thinner in ED patients [75]. Therefore, gentle and meticulous preservation, such as an early release of the NVB, is essential [76,77]. This approach has been previously reported to provide better functional recovery, raising the possibility of traction injury and/or poor visualization [76].…”

Section: Existing Clinical Features and Cn Distributionmentioning

confidence: 89%

Advances in the study of the peripheral nervous system for erection in animals and humans

Hisasue

2011

Reprod Medicine & Biology

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Introduction Since Walsh first emphasized the importance of preserving the neurovascular bundle n to protect the cavernous nerve during pelvic surgery, patients’ sexual life quality has dramatically improved. Today, nerve‐sparing radical prostatectomy is the established gold standard for organ‐confined prostate cancer patients. Recent technical advances in functional assessment such as intraoperative electrical stimulation have unveiled new anatomical features and physiological roles. Basic research has advanced understanding of cavernous nerve function, while molecular biology has uncovered the crucial role of neuronal nitric oxide in mediating erection, and has led to new treatments such as phosphodiesterase type‐5 inhibitors. A recent focus in cavernous nerve research concerns the nerve distribution external to the neurovascular bundle. The cavernous nerves in humans appear to be distributed more widely beneath the lateral pelvic fascia than in other animals, and electrical stimulation studies suggest possible involvement of these nerves in erection. These findings have prompted new surgical techniques such as the “veil of Aphrodite”, or “intrafascial nerve‐sparing” procedures. Materials and Methods These recent anatomical and physiological studies in humans and animals and their impact are reviewed in this article. Conclusions Further investigation should stimulate future advances in strategies to preserve erectile function in RP patients.

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“…Since Walsh and Donker 4 published their landmark article describing the etiology and prevention of impotence following retropubic RP in 1982, the nerve-sparing technique they described is widely employed and believed to improve postoperative erectile function. 5 Furthermore, there continue to be modifications to the nervesparing technique in an attempt to minimize nerve compromise and improve postoperative potency, as reported by Chuang and coauthors 6 and Masterson and colleagues. 7 However, optimal sexual functioning often requires 18 to 42 months to return, even among men in whom bilateral nerve sparing was performed, with reported recovery rates varying from 16% to 86%.…”

Section: Résumémentioning

confidence: 95%

Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art

Al-Shaiji

Domes

Brock

2013

CUAJ

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Despite recent advances in surgical technique using laparoscopic and robotic approaches for the management of early organconfined prostate cancer, most contemporary reports demonstrate significant rates of erectile dysfunction comparable to standard open approaches. Controversy remains related to many of the preand postoperative management strategies, including agents to enhance nerve recovery, erectogenic drugs, antioxidants, vasoactive injectables, vacuum erection devices and nerve grafting procedures. Additionally, the optimal timing of these interventions and their duration, dose, frequency and outcome thresholds remain ill-defined. In our paper, we provide a comprehensive literature review involving both the basic and clinical data surrounding rehabilitative approaches. RésuméMalgré des avancées récentes dans les techniques chirurgicales utilisant la laparoscopie et la robotique pour la prise en charge du cancer de la prostate au stade précoce, la majorité des rapports récents font état de taux significatifs de dysfonction érectile se comparant aux taux associés aux approches ouvertes standard. Bon nombre des stratégies de traitement préopératoires et postopératoires, comme les agents favorisant la récupération nerveuse, les médicaments érec-togènes, les antioxydants, les agents vasoactifs injectables, les pompes péniennes et les greffes de nerfs, font toujours l'objet de controverses. Par ailleurs, le moment optimal pour effectuer ces interventions, la durée de ces dernières, la dose, la fréquence et le seuil d'évaluation des résultats demeurent encore bien mal défi-nis. Cet article de synthèse présente une revue approfondie de la littérature comprenant les données de recherche fondamentale et les données cliniques concernant les approches de réadaptation.going surgery and are thus expressing concern about preservation of erectile function after the procedure, a fact that is true for older men as well. Since Walsh and Donker 4 published their landmark article describing the etiology and prevention of impotence following retropubic RP in 1982, the nerve-sparing technique they described is widely employed and believed to improve postoperative erectile function. 5 Furthermore, there continue to be modifications to the nervesparing technique in an attempt to minimize nerve compromise and improve postoperative potency, as reported by Chuang and coauthors 6 and Masterson and colleagues. 7 However, optimal sexual functioning often requires 18 to 42 months to return, even among men in whom bilateral nerve sparing was performed, with reported recovery rates varying from 16% to 86%. 8,9 Sexual dysfunction has been reported to be an independent determinant of a poorer general health-related quality of life at 2 years after primary treatment for prostate cancer. 10 Recent advances in the understanding of the pathophysiology of postprostatectomy erectile dysfunction (PED) have stimulated great attention directed toward the concept of penile rehabilitation, in which prophylactic measures are instituted to prom...

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Early Release of the Neurovascular Bundles and Optical Loupe Magnification Lead to Improved and Earlier Return of Potency Following Radical Retropubic Prostatectomy

Abstract: Minor modifications in nerve sparing technique lead to improved postoperative potency rates and decreased time to potency in men undergoing RRP.

Cited by 30 publications

References 11 publications

Intraoperative and Early Postoperative Complications of Radical Retropubic Prostatectomy

Intraoperative and Early Postoperative Complications of Radical Retropubic Prostatectomy

Advances in the study of the peripheral nervous system for erection in animals and humans

Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art

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