Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible

Anastasiadis, Aristotelis G.; Benson, Mitchell C.; Rosenwasser, Melvin P.; Salomon, Laurent; El-Rashidy, H; Ghafar, Mohamed A.; McKiernan, James M.; Burchardt, Martin; Shabsigh, Ridwan

doi:10.1038/sj.pcan.4500613

Cited by 34 publications

(16 citation statements)

References 16 publications

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“…99 Recently, Kim et al, 100 in 2001, using sural nerve grafts, reported that 26% (6/28) of men who underwent bilateral sural nerve grafting had regained spontaneous erections sufficient for intercourse, with a total SHIM score of 20. These results were supported by Anastasiadis et al, 101 who reported that 33% (4/ 12) regained spontaneous erections sufficient for intercourse, with a total SHIM score of 20. Currently, the largest group advocating sural nerve grafting is from the Memorial of Sloan Kettering Cancer Centre, who continues to refine the technique of sural nerve grafting as well as intra-operative nerve testing with Cavermap system.…”

Section: Future Directionssupporting

confidence: 80%

Sexual dysfunction after pelvic surgery

et al. 2005

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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...

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Section: Future Directionssupporting

confidence: 80%

Sexual dysfunction after pelvic surgery

et al. 2005

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“…11 The investigators indicated that realization of the full benefits of nerve grafting might not be appreciated until at least 24-36 months after the operation. [11][12][13] In our series, 11 of the 15 patients (73.3%) in Group 1 who had not received either hormone therapy or irradiation in a salvage setting due to biochemical relapse showed the recovery of erectile function. This result was compatible with other studies.…”

Section: Discussionmentioning

confidence: 97%

“…5 Relatively good outcomes from bilateral nerve grafting have been demonstrated by several investigators. [10][11][12][13] Nevertheless, there have been few studies analyzing the impact of this surgical option on HR-QOL. To our knowledge, this is the first study to assess HR-QOL of patients who underwent nervegrafting surgery during a RP prospectively.…”

Section: Discussionmentioning

confidence: 99%

Dissociation of sexual function and sexual bother following autologous sural nerve grafting during radical prostatectomy

Kuwata¹,

Muneuchi

Igawa

et al. 2007

Int J of Urology

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Aim:We prospectively investigated health-related quality of life (HR-QOL), including sexual function and sexual bother, in patients who underwent nerve grafting during a radical prostatectomy in comparison with those who underwent a non-nerve-sparing radical prostatectomy. Methods: Between August 2001 and May 2004, radical prostatectomies were performed on 69 patients with clinical T1-T2N0/M0 prostate cancer. Of these, 66 patients (22: nerve-grafting patients, 44: non-nerve-sparing and non-nerve-grafting patients) were enroled into this study. The observation periods ranged from 12-46 months (median: 29 months). The general HR-QOL was measured with the SF-36 General Health Survey and disease-specific HR-QOL was measured with the University of California Los Angeles-Prostate Cancer Index. Results: Penile tumescence was observed in 11 out of 15 (73.3%) prostate-specific antigen failure-free patients who underwent unilateral nerve grafting with contra-lateral nerve-sparing or bilateral nerve grafting. Vaginal penetration was observed in six out of 15 (40.0%) patients. The time for partial erection and for intercourse, respectively, ranged from 3-21 months (median = 6 months) and 6-36 months (median = 13.5 months). There were no significant differences in general HR-QOL changes over time between the nerve-grafting patients and the patients without any nerve-preserving procedures. The sexual function score was significantly better in the nerve-grafting (bilateral nerve graft or unilateral nerve graft with contra-lateral nerve-sparing) patients than in the non-nerve-sparing/non-nerve-grafting patients. The sexual bother score, however, was more serious for the patients who underwent nerve-grafting surgery than for the non-nerve-sparing/non-nerve-grafting patients. Conclusion: Sexual bother is serious for patients who attempt to maintain sexual function after special surgical procedures, such as nervegrafting surgery. We should be aware that careful counseling is needed to avoid impatient and excessive hope for the recovery of sexual function.

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“…30 Incontinence rates at 12 months were lower for laparoscopic surgery compared to open RRP, with rates of 11.0 % versus 22.3% for diurnal incontinence and 4.0% versus 10.0% for nocturnal incontinence. 44 …”

Section: Urinary Functionmentioning

confidence: 99%

“…41 One study of 300 patients reported higher rates of erectile function for LP compared to RRP (41% vs. 30%, respectively) whether one neurovascular bundle (46% vs. 27%) or two (53% vs. 44%) were preserved. 44 Catalona and colleagues also found that the proportion of men with a return of erectile function increased with the number of prior prostatectomies performed by the surgeon (61% for less than 500, 68% for 500 to 1000, and 70% for 1000 to 1,500; Armitage chi-square 4.8, p = 0.03) and that there was a significant interaction for age by type of surgery (Wald chi-square 6.9, p = 0.009), with the effect of BNS versus UNS on the odds of regaining potency decreasing with increasing age. 41 …”

Section: Erectile Functionmentioning

confidence: 99%

Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

Chin

Srigley

Mayhew

et al. 2013

CUAJ

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Background: The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. Methods:For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. Results:Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. Conclusion:Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary

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Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible

Cited by 34 publications

References 16 publications

Sexual dysfunction after pelvic surgery

Sexual dysfunction after pelvic surgery

Dissociation of sexual function and sexual bother following autologous sural nerve grafting during radical prostatectomy

Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

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