Careful Dissection of the Distal Ureter Is Highly Important in Nerve-sparing Radical Pelvic Surgery: A 3D Reconstruction and Immunohistochemical Characterization of the Vesical Plexus

Kraima, Anne C.; Derks, Marloes; Smit, Noeska; Velde, Cornelis J.H. van de; Kenter, Gemma G.; DeRuiter, Marco C.

doi:10.1097/igc.0000000000000709

Cited by 22 publications

(14 citation statements)

References 24 publications

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“…Despite the introduction of several anastomotic techniques, none of them ensure long‐lasting results (Wiesner & Thüroff, ). The extensive scarring is related to microtraumatisation of the urethral and ureteric vascular plexus that is difficult to omit or even recognise during surgery (Kraima et al, ). Subsequently, developing anoxia due to insufficient blood supply is responsible for surgical urethra (20%) and ureter (40%) repair failures.…”

Section: Current Limitations Of Reconstructive Urologymentioning

confidence: 99%

Reconstructive urology and tissue engineering: Converging developmental paths

Adamowicz

Kuffel

Breda

et al. 2019

J Tissue Eng Regen Med

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Reconstructive urology is a complex and demanding branch of modern urology.Complicated cases, necessity of microsurgical approach, and constant exposure to urine make urinary reconstruction especially difficult. With impaired healing, excessive scarring, and recurring fibrosis, functional results are still not satisfying.For better, more successful outcomes, a novel tissue engineering technology-based solutions are being gradually investigated. The use of tissue engineering is the most promising strategy to improve results of reconstructive urology procedures due to possibility of designing organ-specific grafts. Moreover, targeted modification of healing environment by stem cells and growth factors is a unique opportunity that might bring reconstructive urology on molecular level. This review defined limitations and problems encountered in reconstructive urology and discussed relevant tissue engineering-based achievements in the field of urethra, urinary bladder, and ureter regeneration. The background justifying tissue engineering approach to urethra, urinary bladder, and ureter reconstruction was discussed. Then, the wide range of experimental methods utilising biomaterials and cell seeding was deliberated to show readers the current tools offered by tissue engineering. At the end, we characterised major challenges that are needed to be addressed before tissue entering would become standard technology in urological departments.

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Section: Current Limitations Of Reconstructive Urologymentioning

confidence: 99%

Reconstructive urology and tissue engineering: Converging developmental paths

Adamowicz

Kuffel

Breda

et al. 2019

J Tissue Eng Regen Med

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“…Numerous reports have discussed the details about the anatomy and neurological function of IHP 15–18 , but only several studies have been conducted on the IHC analysis of pelvic nerves 19–24 . There were fewer reports about the IHC method for IHP recognition 19–21 , and almost none compared the areas, proportion or impairment of nerve fibers as we did. A study on 15 donated female cadavers revealed that the cardinal ligament did not contain the PSNs, and a well-defined fascial structure existed in the bottom or dorsal margin of the cardinal ligament area.…”

Section: Discussionmentioning

confidence: 74%

Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy

Wang

et al. 2019

Sci Rep

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Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who received laparoscopic nerve-sparing radical hysterectomy (NSRH) in a randomized controlled study. However, the definite reasons for these results were unknown. This subgroup analysis compared the neural areas and impairment in the IHP uterine branches harvested during NSRH as an alternative to the IHP vesical branches between the waterjet and control groups. This study included samples from 30 eligible patients in each group of the trial NCT03020238. At least one specimen from each side of the IHP uterine branches was resected. The tissues were scanned, images were captured, and the neural component areas were calculated using the image segmentation method. Immunohistochemical staining was used to evaluate neural impairment. The control and waterjet groups had similar areas of whole tissues sent for evaluation. However, the control group had significantly fewer areas (median 272158 versus 200439 μm2, p = 0.044) and a lower percentage (median 4.9% versus 3.0%, p = 0.011) of neural tissues. No significant changes in immunohistochemical staining were found between the two groups. For patients with residual urine ≤100 and >100 ml at 14 days after NSRH (42 and 18 patients, respectively), there were significantly different percentages of neural tissues in the resected samples (p < 0.001). Hence, Due to the accurate identification of IHP during NSRH, the waterjet dissection technique achieved better urodynamic results.

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“…Kraima et al . (18) reported that the bladder branches of the IHP have a more diffuse pattern of distribution in the posterior vesico-uterine ligament, often intimately associated with multiple veins. Therefore, it is often difficult to clearly identify and completely preserve all the bladder branches, and we can only rely on the middle or inferior vesical veins as landmarks for approximate locations of the bladder branches.…”

Section: Discussionmentioning

confidence: 99%

“…Kraima et al . (18) performed an anatomical 3D reconstruction of the IHP bladder branches, showing divergent nerve fibers surrounding the distal ureter within the nerve plane dorsal to the ureter. Therefore, preservation of the dorsal nerve plane can preserve the bladder branches of IHP in a more integral fashion.…”

Section: Discussionmentioning

confidence: 99%

Limited energy parametrial resection/dissection during modified laparoscopic nerve-sparing radical hysterectomy

Zhao¹,

Li²,

Wang³

et al. 2018

Chinese Journal of Cancer Research

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ObjectiveThe aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management, called limited energy parametrial resection/dissection (LEPRD), in laparoscopic nerve plane-sparing radical hysterectomy (NPSRH), a modified nerve-sparing radical hysterectomy (NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.MethodsFrom July 2012 to January 2016, 257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study. Patients were divided into three cohorts according to the different parametrial resection modality. The clinical, pathological and surgery-related parameters were compared between the three groups. Short- and long-term postoperative bladder functions were evaluated.ResultsLEPRD was attempted in 94 patients, and was successful in 65 (69.1%) patients (LEPRD group). The remaining 29 (30.9%) patients required bipolar coagulation after failure of vascular clipping (combined modality group). Routine bipolar cautery was used in the other 163 patients during the parametrial resection (bipolar group). The blood loss in the LEPRD group was significantly lower than those in the other two groups (P<0.001). The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group (P=0.022). The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group (P=0.019).ConclusionsIt is feasible to perform LEPRD in NPSRH for cervical cancers. This kind of limited energy surgical technique is associated with less blood loss, and leads to improved postoperative bladder function.

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Careful Dissection of the Distal Ureter Is Highly Important in Nerve-sparing Radical Pelvic Surgery: A 3D Reconstruction and Immunohistochemical Characterization of the Vesical Plexus

Cited by 22 publications

References 24 publications

Reconstructive urology and tissue engineering: Converging developmental paths

Reconstructive urology and tissue engineering: Converging developmental paths

Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy

Limited energy parametrial resection/dissection during modified laparoscopic nerve-sparing radical hysterectomy

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