Orthotopic Urinary Diversion With Preservation of Erectile and Ejaculatory Function in Men Requiring Radical Cystectomy for Nonurothelial Malignancy: A New Technique

Spitz, Aaron; Stein, John P.; Lieskovsky, Gary; Skinner, Donald G.

doi:10.1016/s0022-5347(05)68794-0

Cited by 86 publications

(53 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[29][30][31][32][33] Urethral-sparing RC in females, prostate and seminal vesicle-sparing RC in males have been shown to improve the sexual function. Preservation of these structures reduces the chances of injury to the cavernosal nerves, without any apparent oncological compromise.…”

Section: Ed In Malesmentioning

confidence: 99%

Sexual dysfunction after pelvic surgery

et al. 2005

View full text Add to dashboard Cite

Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management. International Journal of Impotence Research (2006) IntroductionErectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. 1 Several factors have been implicated in the etiology of ED. Vascular and neurogenic causes are the most common among them. Diabetes, smoking and hypertension are the most important risk factors for vasculogenic sexual dysfunction. Neurological dysfunction is mainly associated with certain neurological syndromes like autonomic neuropathy. Sexual dysfunction after pelvic surgery has been an important and underreported cause of ED. The pathophysiology of sexual dysfunction after pelvic surgery is unique because it can be either vascular or neurogenic factors alone, or a combination of both. The pelvic surgeries in males that are associated with considerable ED include radical prostatectomy (RP), radical cystoprostatectomy (cystectomy) and low anterior or abdominoperineal resections (APRs) for rectal cancer. The pelvic surgeries in females associated with sexual dysfunction include radical cystectomy (RC) for bladder cancer, radical hysterectomy for cancers of the cervix and endometrium and, potentially, simple hysterectomy for benign tumors.In this article, we summarize male and female sexual dysfunction following pelvic surgeries for prostate, bladder and rectal cancer. We also discuss our experience in the treatment of sexual dysfunction following RP and RC. than 10%, urologists still report that the majority of patients experience ED following RRP. [3][4][5] Until recently, ED following RP was not an overwhelming concern, as most prostate cancers were detected in older men. 6 However, since the adven...

show abstract

Section: Ed In Malesmentioning

confidence: 99%

Sexual dysfunction after pelvic surgery

et al. 2005

View full text Add to dashboard Cite

show abstract

“…4 In both cases, the neurovascular bundle, the distal sphinteric complex, and the continuity of the vas, seminal vesicles and ejaculatory duct remain undisturbed.…”

Section: Prostate-sparing Techniquesmentioning

confidence: 98%

The case for prostate capsule-sparing radical cystectomy in selected patients

Klotz

Pinthus

2013

CUAJ

View full text Add to dashboard Cite

Can Urol Assoc J 2009;3(Suppl4): S215-9 R adical cystoprostatectomy and neobladder replacement have become the gold standard for patients with invasive bladder cancer. Although the neobladder represents a significant improvement over ileal conduit, in terms of the effect on body image, the operation has a significant impact on many quality-of-life-related domains. Erectile function and incontinence (particularly nocturnal) are common. Nerve-sparing cystectomy is associated with a relatively low rate of erectile function preservation. 1 The impetus for traditional cystectomy including en bloc dissection of the entire prostate arose because of reports that occult transitional cell carcinoma (TCC) and prostate cancer were prevalent in the prostate of these men. In this article, we present the case that prostate capsule-sparing radical cystectomy, with appropriate and careful patient selection and surgical technique reduces the risk of local recurrence and improves quality of life. Prostate-sparing techniquesDifferent techniques have been described, with several common motifs. All of these techniques preserve a portion of the prostatic capsule, the seminal vesicles and the vas deferens, but vary in the types of prostate resection and neobladder configuration. 2 Importantly, all authors advocate removal of part of the prostate. "Prostate sparing" actually refers either to subtotal prostatic resection or resection of the adenoma with capsule sparing.The two main techniques are (1) removal of the prostatic adenoma using the technique of a Millen simple retropubic prostatectomy, excising the adenoma tissue containing the prostatic ducts and most acini, leaving the surgical capsule and seminal vesicles intact, 3 and (2) a transverse excision through the proximal prostate, leaving the distal prostate, including the distal adenoma and seminal vesicles and utricle, intact. 4 In both cases, the neurovascular bundle, the distal sphinteric complex, and the continuity of the vas, seminal vesicles and ejaculatory duct remain undisturbed.The critical two questions are (1) What is the risk of local recurrence in the residual prostate tissue? and (2) What are the quality-of-life results (e.g., voiding, continence and erectile function)?Patient selection is a critical component of the procedure. Patients who are at increased risk for prostatic urethral involvement should be excluded. Identifying these patients involves several steps. Patients should be candidates for a neobladder on the basis of age, comorbidity, and extent of disease. T4 cases are excluded. The primary cancer should not directly involve the bladder neck or prostatic urethra. Diffuse, multifocal carcinoma in situ (CIS) increases the risk of prostatic involvement and is a contraindication. (Focal CIS in the peri-tumoural area is not a contraindication.) Patients who have no CIS, multifocality or bladder neck involvement have an extremely low rate of prostatic urethral involvement; in one series, 0 of 40 patients experienced prostatic urethral involvement. 5

show abstract

“…Spitz et al [23] recently reported a small series of fertility-and nerve-sparing cystectomies in four young patients, all of whom had nontransitional cell malignancies. This approach, which involves sparing part of the posterior prostate, seminal vesicles and ejaculatory duct, incorporates a nerve-stimulating approach.…”

Section: Other Uses For Cavernosal Nerve Mapping: Nerve Grafts and Nementioning

confidence: 99%

Cavernosal nerve mapping: current data and applications

Klotz

2003

BJU International

View full text Add to dashboard Cite

There are four reviews in this month's section, two relating to the technical aspects of treating prostate cancer, one to genetic instability and bladder cancer, and the final one about continence surgery in urogenital prolapse. The authors are from Canada, the USA, and the UK. The messages from all of the reviews are clear, and provide interesting reading. The contributions to this section continue to give considerable information, and there are many more to follow.Although nerve‐sparing prostatectomy is widely practised, the results with respect to preserving potency often do not meet expectations. The concept of intraoperative cavernosal nerve stimulation is reasonable. Data that link the response to sildenafil after prostatectomy with bilateral nerve sparing has increased the importance of optimizing nerve sparing. The cavernosal nerves are often difficult to visualize and may have a variable course. A tumescent response to nerve stimulation can be shown consistently; the response may be subtle, and characterized by a minimal increase in penile circumference and blood flow. Immediately after prostatectomy, proximal nerve stimulation identifies whether neural continuity has been maintained, and is predictive of recovery of erectile function. The CavermapTM system (Uromed Corporation, Boston, MA, USA) was developed to permit intraoperative nerve stimulation with tumescence monitoring. An initial phase 2 and subsequent phase 3 single‐blinded, randomized, multicentre study that compared Cavermap‐assisted prostatectomy with conventional nerve sparing showed a significant benefit in terms of the duration of nocturnal tumescence at 1 year. Other approaches are being explored, including incorporating the device into sural or genito‐femoral nerve grafting, use of nerve stimulation during cystectomy or abdominal‐perineal resection, and direct corpus cavernosal pressure monitoring during nerve stimulation. These approaches warrant further evaluation.

show abstract

Orthotopic Urinary Diversion With Preservation of Erectile and Ejaculatory Function in Men Requiring Radical Cystectomy for Nonurothelial Malignancy: A New Technique

Cited by 86 publications

References 1 publication

Sexual dysfunction after pelvic surgery

Sexual dysfunction after pelvic surgery

The case for prostate capsule-sparing radical cystectomy in selected patients

Cavernosal nerve mapping: current data and applications

Contact Info

Product

Resources

About