Male sexual function after autonomic nerve-preserving operation for rectal cancer

Masui, Hidenobu; Ike, Hideyuki; Yamaguchi, Shigeki; Oki, Sadaaki; Shimada, Hiroshi

doi:10.1007/bf02081416

Cited by 155 publications

(78 citation statements)

References 23 publications

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“…In the literature the authors do not agree on the safest point for ligation of the ima which avoids damage to the nervous system [26, 27, 28, 29, 30]. There is no work specifically dedicated to the anatomical study of this problem; furthermore none of the authors who have worked on this subject have carried out measurements to support their own statements.…”

Section: Discussionmentioning

confidence: 89%

Ligation of the Inferior Mesenteric Artery in the Surgery of Rectal Cancer: Anatomical Considerations

et al. 2004

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Background: No agreement has been found in the literature concerning the safest point of ligation of the inferior mesenteric artery (ima) in order to avoid nerve damage during the surgery of rectal cancer. Study Design: The distance between the origin of the ima and the left paraortic trunk was measured, as was the distance between the left paraortic trunk and the origin of the left colic artery (lca). The measurements were carried out on 20 cadavers and during 22 operations for rectal cancer. Results: The left paraortic trunk always runs posterior to the ima: its distance from the origin of the ima is on average 1.2 cm; the distance of the left paraortic trunk from the origin of the lca is on average 0.4 cm. The point at which the ima and the left paraortic trunk cross varies greatly, but it is never near the origin of the ima. Conclusions: From an anatomical point of view the safest point of ligation of the ima is at its origin. At this point, the left paraortic trunk never runs; so there isn’t any risk to damage the nerve involving it during the ligation of the artery.

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Section: Discussionmentioning

confidence: 89%

Ligation of the Inferior Mesenteric Artery in the Surgery of Rectal Cancer: Anatomical Considerations

et al. 2004

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“…Urinary, sexual and anorectal dysfunction may occur as postoperative complications following pelvic surgery, especially after rectal excision for rectal carcinoma [1,2,3,4]. This is mainly the result of intraoperative injury to the pelvic autonomic nerves.…”

Section: Introductionmentioning

confidence: 99%

Selective Pelvic Autonomic Nerve Stimulation with Simultaneous Intraoperative Monitoring of Internal Anal Sphincter and Bladder Innervation

et al. 2011

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Background: Pelvic autonomic nerve preservation avoids postoperative functional disturbances. The aim of this feasibility study was to develop a neuromonitoring system with simultaneous intraoperative verification of internal anal sphincter (IAS) activity and intravesical pressure. Methods: 14 pigs underwent low anterior rectal resection. During intermittent bipolar electric stimulation of the inferior hypogastric plexus (IHP) and the pelvic splanchnic nerves (PSN), electromyographic signals of the IAS and manometry of the urinary bladder were observed simultaneously. Results: Stimulation of IHP and PSN as well as simultaneous intraoperative monitoring could be realized with an adapted neuromonitoring device. Neurostimulation resulted in either bladder or IAS activation or concerted activation of both. Intravesical pressure increase as well as amplitude increase of the IAS neuromonitoring signal did not differ significantly between stimulation of IHP and PSN [6.0 cm H₂O (interquartile range [IQR] 3.5–9.0) vs. 6.0 cm H₂O (IQR 3.0–10.0) and 12.1 µV (IQR 3.0–36.7) vs. 40.1 µV (IQR 9.0–64.3)] (p > 0.05). Conclusions: Pelvic autonomic nerve stimulation with simultaneous intraoperative monitoring of IAS and bladder innervation is feasible. The method may enable neuromonitoring with increasing selectivity for pelvic autonomic nerve preservation.

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“…Both nerves have to be identified and preserved, since even unilateral injury may be sufficient to cause retrograde ejaculation. 14,15 Once the dissection progresses distally, the bifurcation of the hypogastric plexus and the 2 hypogastric nerves are easily identified and have the appearance of a wishbone (Figure 6). …”

Section: Posterior Dissectionmentioning

confidence: 99%

A Simple Technique for Identification and Preservation of the Hypogastric Nerves During Rectal Surgery

Morpurgo¹,

Hall²,

Galandiuk³

2004

Arch Surg

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Male sexual function after autonomic nerve-preserving operation for rectal cancer

Abstract: Pelvic plexus preservation is necessary to maintain erectile potency, and both hypogastric nerve and pelvic plexus preservation are necessary to maintain ejaculate function and orgasm. To maintain satisfactory sexual function, complete autonomic nerve-preserving operation is suitable.

Cited by 155 publications

References 23 publications

Ligation of the Inferior Mesenteric Artery in the Surgery of Rectal Cancer: Anatomical Considerations

Ligation of the Inferior Mesenteric Artery in the Surgery of Rectal Cancer: Anatomical Considerations

Selective Pelvic Autonomic Nerve Stimulation with Simultaneous Intraoperative Monitoring of Internal Anal Sphincter and Bladder Innervation

A Simple Technique for Identification and Preservation of the Hypogastric Nerves During Rectal Surgery

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