Improving the Preservation of the Urethral Sphincter and Neurovascular Bundles During Open Radical Retropubic Prostatectomy

Montorsi, Francesco; Salonia, Andrea; Suardi, Nazareno; Gallina, Andrea; Zanni, Giuseppe; Briganti, Alberto; Dehò, Federico; Naspro, Richard; Farina, Elena; Rigatti, Patrìzio

doi:10.1016/j.eururo.2005.09.004

Cited by 141 publications

(60 citation statements)

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“…On the basis of the findings of these studies, some authors have advocated a modification of the standard nerve-sparing approach aimed at maximizing nerve fiber preservation. [23][24][25] Montorsi et al 23 have suggested a technique using a high anterior incision of the levator and prostatic fasciae (1 and 11 o'clock positions) over the prostate. This allows development of the plane between the prostatic capsule and prostatic fascia (intrafascial approach) to displace the neurovascular network located between the 2 fasciae laterally and to preserve nerve fibers located on the ventral part of the prostate.…”

Section: Original Article 3152mentioning

confidence: 99%

“…In a small cohort of 42 patients who underwent surgery with an intrafascial nerve-sparing approach, the rate of full erectile function recovery (defined as an IIEF-erectile function [IIEF-EF] domain score 26) was as high as 52% at 6-month follow-up. 23 Recently, Masterson and collegues 24 conducted a retrospective, nonrandomized comparison of functional outcome associated with a standard nerve-sparing technique compared with a modified nerve-sparing approach. In the modified technique, the NVB was mobilized completely off the prostate from the apex to above the seminal vesicles, including incision of Denonvillier fascia, before urethral division and mobilization of the prostate off the rectum.…”

Section: Original Article 3152mentioning

confidence: 99%

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Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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Section: Original Article 3152mentioning

confidence: 99%

Section: Original Article 3152mentioning

confidence: 99%

Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, clinically, the recovery of erectile function cannot be observed in all patients who are supposed to experience the partial nerve damage that occurs during nerve-sparing radical prostatectomy (6). As a result, stem cell therapy has been introduced as one of therapeutic options to help the preservation and restoration of erectile function in these patients (4). Therefore, we administered MSCs to MPG to evaluate the infl uence on the recovery of neurogenic erectile dysfunction by bilateral cavernous crushing injury.…”

Section: Discussionmentioning

confidence: 99%

“…Erectile dysfunction is a bothersome complaint among pa-tients submitted to radical prostatectomy and it is an important reason for the decrease of the quality of life in these patients. Therefore, nerve-sparing procedures have been proposed to reduce short--term and long-term functional complications such as erectile dysfunction (3)(4)(5). However, some patients submitted to radical prostatectomy with nerve-sparing technique have been experiencing erectile dysfunction and need other treatments to improve their symptoms (6).…”

Section: Introductionmentioning

confidence: 99%

Effect of Mesenchymal Stem Cells Associated to Matrixen on the Erectile Function in the Rat Model with Bilateral Cavernous Nerve Crushing Injury

et al. 2012

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Objectives:To evaluate the effect of mesenchymal stem cells (MSCs) and MSCs mixed with Matrixen as a cell carrier on the erectile dysfunction caused by bilateral cavernous nerve crushing injury. Materials and Methods: White male Sprague-Dawley rats were divided into 4 groups: sham-operated control group (n = 5), bilateral cavernous nerve crushing group (BCNC group, n = 10), BCNC administered with MSCs group (n = 10,1x106 in 20 µL), BCNC administered with Matrixen group (n = 10.1x106 in 20 µL), BCNC administered with MSCs/Matrixen group (n = 10.1x106 in 20 µL). After functional assessment at 4 weeks, major pelvic ganglion (MPG) and penile tissue were collected. Immunofl uorescent staining of MPG was performed with PKH26 and Tuj1. Western blot analysis of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) were done in corpus cavernosum. Results: ICP/MAP ratios of BCNC with MSCs and MSCs/Matrixen groups were significantly increased compared with BCNC and BCNC with Matrixen group. Moreover, ICP/ MAP ratios of MSCs/Matrixen group were signifi cantly increased compared with BCNC with MSCs group. In MPG, the more implantation of MSCs and increased expression of nerve cells were observed in MSCs/Matrixen group compared with BCNC with MSCs group. Signifi cant increase expression of eNOS and nNOS was also noted in BCNC with MSCs/Matrixen group. Conclusion: The erectile function was more preserved in MSCs/Matrixen group compared with the administration of MSCs alone in the rats with bilateral cavernous nerve crushing injury. Therefore, we consider that the use of transplant cell carrier such as Matrixen may help the implantation of MSCs and improve the therapeutic effect of MSCs. INTRODUCTIONDiagnosis of prostate cancer has been elevating due to the increase in prostate-specifi c antigen (PSA) screening. In addition, this earlier diagnosis increases the number of patients presenting with clinically organ-confi ned disease and therefore, it has led to an increase of the number of candidates for radical prostatectomy (1,2). Radical prostatectomy has been associated with complications such as postoperative urinary incontinence and erectile dysfunction. Erectile dysfunction is a bothersome complaint among pa-

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“…Many other important contributions have provided, by detailed anatomical studies, the optimization of the surgical technique, with the purpose of reducing short-term and long-term complications (3)(4)(5)(6)(7)(8)(9)(10). Regardless of the vital importance of cancer control, patients are frequently concerned with any negative effects on urinary continence and sexual potency after surgery.…”

Section: Introductionmentioning

confidence: 99%

Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy?

Ferronha¹,

Barros²,

Santos³

et al. 2011

Int. braz j urol.

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Purpose: To compare the perioperative, short-term and long-term postoperative results of radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robotic assisted laparoscopic prostatectomy (RALP) in the most recent studies evaluable. Materials and Methods: Using PubMed we have undertaken a search based on references from major and recent articles with considerable sample sizes. Results: The operative blood loss and the risk of transfusion were lower in the laparoscopic and robotic-assisted approaches. The surgical duration was shorter in the open and robotic group. Regarding the positive margins, continence and potency no substantial differences between the RRP, LRP, and RALP were found. Conclusions: Our results suggest that no one surgical approach is superior in terms of functional and early oncologic outcomes. Potential advantages of any surgical approach have to be confirmed through longer-term follow-up and adequately designed clinical studies.

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Improving the Preservation of the Urethral Sphincter and Neurovascular Bundles During Open Radical Retropubic Prostatectomy

Cited by 141 publications

References 14 publications

Prediction of sexual function after radical prostatectomy

Prediction of sexual function after radical prostatectomy

Effect of Mesenchymal Stem Cells Associated to Matrixen on the Erectile Function in the Rat Model with Bilateral Cavernous Nerve Crushing Injury

Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy?

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