Perioperative and Pathological Outcome of Nerve-Sparing Radical Cystectomy With Ileal Neobladder

Vogt, Katharina; Netsch, Christopher; Becker, Benedikt; Oye, Sebastian; Gross, Andreas J.; Rosenbaum, Clemens M.

doi:10.3389/fsurg.2021.652958

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…Further the potential ability to utilize DESI‐MSI techniques in real time could provide an unprecedented advantage for surgical decision making. Nerve‐sparing procedures, for example, are continually being innovated to mitigate iatrogenic outcomes (Kyriazis et al, 2022 ; Vogt et al, 2021 ), though do not currently take advantage of distinguishing tissues at the molecular level.…”

Section: Introductionmentioning

confidence: 99%

Molecular characterization of human peripheral nerves using desorption electrospray ionization mass spectrometry imaging

et al. 2023

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Desorption electrospray ionization mass spectrometry imaging (DESI‐MSI) is a molecular imaging method that can be used to elucidate the small‐molecule composition of tissues and map their spatial information using two‐dimensional ion images. This technique has been used to investigate the molecular profiles of variety of tissues, including within the central nervous system, specifically the brain and spinal cord. To our knowledge, this technique has yet to be applied to tissues of the peripheral nervous system (PNS). Data generated from such analyses are expected to advance the characterization of these structures. The study aimed to: (i) establish whether DESI‐MSI can discriminate the molecular characteristics of peripheral nerves and distinguish them from surrounding tissues and (ii) assess whether different peripheral nerve subtypes are characterized by unique molecular profiles. Four different nerves for which are known to carry various nerve fiber types were harvested from a fresh cadaveric donor: mixed, motor and sensory (sciatic and femoral); cutaneous, sensory (sural); and autonomic (vagus). Tissue samples were harvested to include the nerve bundles in addition to surrounding connective tissue. Samples were flash‐frozen, embedded in optimal cutting temperature compound in cross‐section, and sectioned at 14 μm. Following DESI‐MSI analysis, identical tissue sections were stained with hematoxylin and eosin. In this proof‐of‐concept study, a combination of multivariate and univariate statistical methods was used to evaluate molecular differences between the nerve and adjacent tissue and between nerve subtypes. The acquired mass spectral profiles of the peripheral nerve samples presented trends in ion abundances that seemed to be characteristic of nerve tissue and spatially corresponded to the associated histology of the tissue sections. Principal component analysis (PCA) supported the separation of the samples into distinct nerve and adjacent tissue classes. This classification was further supported by the K‐means clustering analysis, which showed separation of the nerve and background ions. Differences in ion expression were confirmed using ANOVA which identified statistically significant differences in ion expression between the nerve subtypes. The PCA plot suggested some separation of the nerve subtypes into four classes which corresponded with the nerve types. This was supported by the K‐means clustering. Some overlap in classes was noted in these two clustering analyses. This study provides emerging evidence that DESI‐MSI is an effective tool for metabolomic profiling of peripheral nerves. Our results suggest that peripheral nerves have molecular profiles that are distinct from the surrounding connective tissues and that DESI‐MSI may be able to discriminate between nerve subtypes. DESI‐MSI of peripheral nerves may be a valuable technique that could be used to improve our understanding of peripheral nerve anatomy and physiology. The ability to utilize ambient mass spectrometry techniques in real time could also provide an unprecedented advantage for surgical decision making, including in nerve‐sparing procedures in the future.

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Section: Introductionmentioning

confidence: 99%

Molecular characterization of human peripheral nerves using desorption electrospray ionization mass spectrometry imaging

et al. 2023

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“…When performing radical cystectomy (RC), nerve-sparing surgery should be aspired for when feasible as stated in the current guideline by the European Association of Urology [ 14 ]. In addition to urinary incontinence, erectile dysfunction (ED) following surgery may also negatively influence quality of life [ 5 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of functional outcomes in 395 patients with an ileal neobladder 1 year after radical cystectomy

et al. 2023

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Purpose This study aims to report on functional outcomes in a large cohort of patients who underwent inpatient rehabilitation (IR) in a highly specialized, high-volume German urologic rehabilitation center after radical cystectomy (RC) and creation of an ileal neobladder (INB). Methods Data for 842 patients, who underwent three weeks of IR after RC and urinary diversion between April 2018 and December 2019 were prospectively collected. INB patients were surveyed on continence and sexual function. Data were collected at 4 weeks (T1), 6 months (T2), and 12 months (T3) after RC. Multivariate logistic regressions were performed to identify predictors of better functional outcomes. Results INB was chosen as urinary diversion in 395 patients (357 male, 38 female). Social continence (maximum of one safety pad/24 h) was reported by 78.3% of men and 64.0% of women at T3. Severe incontinence was reported by 27.3% of men and 44.0% of women. Male sex was identified as an independent predictor for the use of no pads at T3 (OR 4.110; 95% CI 1.153–14.655; p = 0.029). Nerve-sparing surgery was identified as an independent predictor both for the use of only a safety pad (OR 1.918; 95% CI 1.031–3.569; p = 0.040) and good erectile function at T3 (OR 4.377; 95% CI 1.582–12.110; p = 0.004). Conclusion Urologists should aspire for nerve-sparing surgery. When advising patients before RC, functional outcomes (continence, sexual function) should be given special attention. Women should be counseled on potentially prolonged urinary incontinence.

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Lebensqualität nach radikaler Zystektomie: Was zählt wirklich?

Rosenbaum¹

2021

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Perioperative and Pathological Outcome of Nerve-Sparing Radical Cystectomy With Ileal Neobladder

Cited by 7 publications

References 21 publications

Molecular characterization of human peripheral nerves using desorption electrospray ionization mass spectrometry imaging

Molecular characterization of human peripheral nerves using desorption electrospray ionization mass spectrometry imaging

Prospective evaluation of functional outcomes in 395 patients with an ileal neobladder 1 year after radical cystectomy

Lebensqualität nach radikaler Zystektomie: Was zählt wirklich?

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