Nerves At The Ventral Prostatic Capsule Contribute To Erectile Function: Initial Electrophysiological Assessment In Humans

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Prostate / Prostate Cancer;  Urology / Nephrology
Article Date: 24 Nov 2008 - 3:00 PST

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UroToday.com - When performing nerve sparing radical prostatectomy, how high up on the lateral prostatic fascia do urologists need to go to release the neurovascular bundle (NVB)? Are there even functional nerve fibers higher than the main bundle located at the 5 o'clock position? This question is answered by Dr. Yasuhiro Kaiho and colleagues at Tohoku University in an online report that appeared in European Urology.

The investigators studied 12 potent men who underwent nerve sparing radical prostatectomy. Electrophysiological evaluation of functional periprostatic fascia was performed by stimulation to the periprostatic nerve network. The circumference of the prostate was labeled as 12 o'clock at the anterior (top) position, 5 o'clock at the NVB and 1, 2, 3, 4 in between. These positions were stimulated at the mid-prostate for 30 seconds at 30mA in a monophasic pulse with pulse duration of 1.0ms. Response was measured as changes in urethral pressure at the middle portion of the penile shaft using an inserted balloon catheter to detect increases in cavernosal pressure. The amplitude responses for the 12 patients at each position on the prostate were averaged and compared to the other positions.

The amplitude was greatest when electrostimulation was applied at the 5 o'clock position, followed by the 4 o'clock position and decreased up to the 12 o'clock position. This relatively straightforward data suggests that the 5 and 4 o'clock positions are the primary nerve sites, but additive benefit of additional sites was not evaluable.

Thus, mobilization of the lateral prostatic fascia as medially as possible will help to protect the most nerves possible.

Kaiho Y, Nakagawa H, Saito H, Ito A, Ishidoya S, Saito S, Arai Y
Eur Urol. 2008 Sep 24. Epub ahead of print.
doi:10.1016/j.eururo.2008.09.022

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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