For surgeons in training the Lichtenstein open mesh technique is a better method of inguinal hernia repair than the Shouldice technique. The outcome is better for the patients and it is more cost-effective.
24 men suffering from localized prostatic cancer undergoing radical retropubic nerve-sparing prostatectomy were investigated by the following electrophysiological methods: Bulbocavernosus reflexes elicited from the penile skin or the posterior urethra, sensory thresholds in the posterior urethra, cerebral evoked potentials after stimulation of the pudendal nerve or the posterior urethra. 15 men were examined 4-33 months postoperatively only, 5 men were examined only preoperatively and 4 men were examined both pre- and postoperatively. 10 men suffering from minor problems due to benign prostatic hyperplasia served as controls. In patients with localized cancer of the prostate, the findings did not differ from those in the control group. In the operated group the findings were pathological in a large proportion of the patients, indicating injuries both to nervous pathways running through the pelvic nerve plexus and in the pudendal nerve. The conclusions were: Localized cancer of the prostate has minimal or no risk at all of impaired functioning in the pelvic nervous pathways. Radical retropubic prostatectomy may in some cases be undertaken without any objective evidence of injury to these nervous pathways, but is often followed by findings indicating such injury. The dorsal nerve of the penis may be affected by the operation. Transcranial stimulation of the motor cortex is a useful method in the evaluation of prolonged or absent bulbocavernosus reflexes.
Following electrical stimulation of the posterior urethra, visceral afferent nerves are excited that transmit sensory information perceived as an imminent desire to void. In the present study, some basic psychophysical relations involved in the sensations evoked this way were investigated. The results included the following. First, in the temporal integration relation, the relation between the sensory threshold (sT) and the duration of the stimulus (Dj followed a power function: sT*DK = m, in which K and m are constants. Second, in 20 healthy subjects, the sensory threshold dctcrmincd with increasing strength (sT,j and determined with decreasing strength (sTd) were linearly correlated (P~O.001). The slope of the relations between sT, and sT, decrcascd with the duration of stimulus. Third, the sT, and sT, were inversely related to the frequency of the stimulus. Fourth, the relation between the mean reaction time (RT) and the stimulus strength (I) followed a significant power function fit after stimulation in the postcrior urethra (R = 0.93, P~0.001): RT = 8 * I-", in which d and n are constants. Finally, stimulation of the penile skin either electrically, with vibration or with a cold stimulus, caused a significant increase in the sensory thresholds determined in the posterior urethra. The conclusion of the study was that sensations evoked by electrical stimulation of visceral afferent pathways in the posterior urethra follow psychophysical power functions similar to those of exteroceptive sensory modalities.
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