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Vorteile der nerverhaltenden Beckenchirurgie

Tierexperimentelle und klinische Ergebnisse

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Zusammenfassung

Bei der chirurgischen Therapie urogenitaler Tumoren standen in der Vergangenheit ausschließlich die onkologischen Ergebnisse im Vordergrund. Die Anzahl früh diagnostizierter Tumoren hat, in Kombination mit neueren Kenntnissen in Anatomie und Physiologie der Beckenorgane und deren Innervation, zur Verbesserung der operativen Techniken geführt. Gerade bei jüngeren Patienten gewinnen neben onkologischen auch funktionelle Aspekte der Behandlung, insbesondere im Bereich der Sexual- und der Miktionsfunktion, immer mehr an Bedeutung. Die Schonung autonomer Nerven ist für die Aufrechterhaltung der postoperativen Funktion der Becken- und Genitalorgane von ausschlaggebender Bedeutung. In der vorliegenden Arbeit sollen tierexperimentelle und klinische Ergebnisse nach nerverhaltender Beckenchirurgie unter Berücksichtigung geschlechtsspezifischer Unterschiede dargestellt werden.

Abstract

Traditionally, oncological factors have been the only ones used in the evaluation of treatment outcome for urological tumor patients. With increased diagnoses of early, curable tumors in younger individuals, health-related quality of life and functional aspects are gaining importance. Sexual and urinary function are significant aspects of quality of life, which are especially vulnerable in urological patients. New insights into the anatomy and physiology of the pelvic organs have resulted in an improvement in surgical therapy. In this article, we present the results of current experimental and clinical studies, which underline the importance of nerve sparing techniques for maintaining a satisfying urinary and sexual function in this patient population.

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Literatur

  1. Biers SM, Brading AF (2003) Nerve regeneration: might this be the only solution for functional problems of the urinary tract? Curr Opin Urol 13: 495–500

    Article  PubMed  Google Scholar 

  2. Brendler CB, Steinberg GD, Marshall FF, Mostwin JL, Walsh PC (1990) Local recurrence and survival following nerve-sparing radical cystoprostatectomy. J Urol 144: 1137–1140

    CAS  PubMed  Google Scholar 

  3. Burnett AL, Calvin DC, Silver RI, Peppas DS, Docimo SG (1997) Immunohistochemical description of nitric oxide synthase isoforms in human clitoris. J Urol 158: 75–78

    PubMed  Google Scholar 

  4. Catalona WJ, Bigg SW (1990) Nerve-sparing radical prostatectomy: evaluation of results after 250 patients. J Urol 143: 538–543

    CAS  PubMed  Google Scholar 

  5. Chang DW, Wood CG, Kroll SS, Youssef AA, Babaian RJ (2003) Cavernous nerve reconstruction to preserve erectile function following non-nerve-sparing radical retropubic prostatectomy: a prospective study. Plast Reconstr Surg 111: 1174–1181

    Article  PubMed  Google Scholar 

  6. Colleselli K, Stenzl A, Eder R, Strasser H, Poisel S, Bartsch G (1998) The female urethral sphincter: a morphological and topographical study. J Urol 160: 49–54

    CAS  PubMed  Google Scholar 

  7. De Petriconi R, Kleinschmidt K, Flohr P, Paiss T, Hautmann R (1996) Ileal neobladder with anastomosis to the female urethra. Urologe A 35: 284–290

    PubMed  Google Scholar 

  8. Doolabh VB, Hertl MC, Mackinnon SE (1996) The role of conduits in nerve repair: a review. Rev Neurosci 1: 47–84

    Google Scholar 

  9. Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, Scardino PT (1996) Risk factors for urinary incontinence after radical prostatectomy. J Urol 156: 1707–1713

    CAS  PubMed  Google Scholar 

  10. Hollabaugh RS Jr, Dmochowski RR, Kneib TG, Steiner MS (1998) Preservation of putative continence nerves during radical retropubic prostatectomy leads to more rapid return of urinary continence. Urology 51: 960–967

    Article  PubMed  Google Scholar 

  11. Jakse G, Brehmer B, Borchers H, Verger-Kuhnke A, Biesterfeld S (2003) Potency-sparing radical perineal prostatectomy. Urologe A 42: 382–386

    CAS  PubMed  Google Scholar 

  12. Katz R, Salomon L, Hoznek A et al. (2002) Patient reported sexual function following laparoscopic radical prostatectomy. J Urol 168: 2078–2082

    PubMed  Google Scholar 

  13. Kihara K, Sato K, Kageyama Y, Inoue Y (2001) Reconstruction of the canine pelvic nerve and its application to bladder transplantation. Neurourol Urodyn 20: 187–196

    Article  CAS  PubMed  Google Scholar 

  14. Kim ED, Scardino PT, Hampel O, Mills NL, Wheeler TM, Nath RK (1999) Interposition of sural nerve restores function of cavernous nerves resected during radical prostatectomy. J Urol 161: 188–192

    CAS  PubMed  Google Scholar 

  15. Kim ED, Nath R, Slawin KM, Kadmon D, Miles BJ, Scardino PT (2001) Bilateral nerve grafting during radical retropubic prostatectomy: extended follow-up. Urology 58: 983–987

    Article  CAS  PubMed  Google Scholar 

  16. Leungwattanakij S, Bivalacqua TJ, Usta MF, Yang DY, Hyun JS, Champion HC, Abdel-Mageed AB, Hellstrom WJ (2003) Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 24: 239–245

    PubMed  Google Scholar 

  17. Lundborg G, Kanje M (1996) Bioartificial nerve grafts. A prototype. Scand J Plast Reconstr Surg Hand Surg 2: 105–110

    Google Scholar 

  18. Martinez-Pineiro L, Dahiya R, Brock GB, Hsu GL, von Heyden B, Lue TF (1995) Chronic penile denervation in the rat: effect on cavernous tissue morphology and function. Int J Impot Res 7: 165–174

    CAS  PubMed  Google Scholar 

  19. May F, Weidner N, Mrva T, Caspers C, Matiasek K, Gaensbacher B, Hartung (2003) Nerve guides seeded with Schwann cells are very effective for repair of ablated cavernosal nerves in rats. J Urol 4: 304

    Google Scholar 

  20. McKenna KE (2002) The neurophysiology of female sexual dysfunction. World J Urol 20: 93–100

    Article  PubMed  Google Scholar 

  21. Mills RD, Studer UE (2000) Female orthotopic bladder substitution: a good operation in the right circumstances. J Urol 163: 1501–1504

    Article  Google Scholar 

  22. Mitsui T, Kobayashi S, Matsuura S, Kakizaki H, Mori T, Minami S, Koyanagi T (1998) Vesicourethral dysfunction following radical surgery for rectal carcinoma: change in voiding pattern on sequenzial urodynamic studies and impact of nerve-sparing surgery. Int J Urol 5: 35–38

    CAS  PubMed  Google Scholar 

  23. Noldus J, Graefen M, Hammerer P, Henke RP, Huland H (1998) Development of tumor selection based on pathological stage in clinically localized prostate carcinoma. Urologe A 37: 195–198

    Article  CAS  PubMed  Google Scholar 

  24. Noldus J, Michl U, Graefen M, Haese A, Hammerer P, Fernandez S, Huland H (2001) Nerve-sparing radical retropubic prostatectomy. Results of a patient survey. Urologe A 40: 102–106

    Article  CAS  PubMed  Google Scholar 

  25. O’Donnell PD, Finan BF (1989) Continence following nerve-sparing radical prostatectomy. J Urol 142: 1227–1228

    CAS  PubMed  Google Scholar 

  26. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49: 822–830

    CAS  PubMed  Google Scholar 

  27. Seckel BR (1990) Enhancement of peripheral nerve regeneration. Muscle Nerve. 9: 785–800

    Google Scholar 

  28. Steers WD (2000) Voiding dysfunction in the orthotopic neobladder. World J Urol 18: 330–337

    CAS  PubMed  Google Scholar 

  29. Steiner MS, Morton RA, Walsh PC (1991) Impact of anatomical radical prostatectomy on urinary continence. J Urol 145: 512–514

    CAS  PubMed  Google Scholar 

  30. Stenzl A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G (1995) Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol 154: 2044–2049

    CAS  PubMed  Google Scholar 

  31. Stenzl A, Jarolim L, Coloby P et al. (2001) Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors. Cancer 92: 1864–1871

    Article  CAS  PubMed  Google Scholar 

  32. Strasser H, Ninkovic M, Hess M, Bartsch G, Stenzl A (2000) Anatomic and functional studies of the male and female urethral sphincter. World J Urol 18: 324–329

    Article  CAS  PubMed  Google Scholar 

  33. Turner WH, Danuser H, Moehrle K, Studer UE (1997) The effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. J Urol 158: 2118–2122

    CAS  PubMed  Google Scholar 

  34. Van der Werf BA, Creed KE (2002) Mechanical properties and innervation of the smooth muscle layers of the urethra of greyhounds. BJU Int 90: 588–595

    Article  PubMed  Google Scholar 

  35. Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128: 492–497

    CAS  PubMed  Google Scholar 

  36. Walsh PC, Mostwin JL (1984) Radical prostatectomy and cystoprostatectomy with preservation of potency. Results using a new nerve-sparing technique. Br J Urol 56: 694–697

    CAS  PubMed  Google Scholar 

  37. Walsh PC, et al. (2000) Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55: 58–61

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Urologie am Klinikum der Eberhard-Karls-Universität Tübingen

    A. Stenzl, A. G. Anastasiadis, S. Corvin, G. Feil & M. Kuczyk

  2. Urologische Universitätsklinik Innsbruck

    H. Strasser

  3. Klinik für Urologie der Eberhard-Karls-Universität, Hoppe-Seyler-Straße 3, 72076 , Tübingen

    A. Stenzl

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  1. A. Stenzl
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  2. A. G. Anastasiadis
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  3. S. Corvin
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  4. G. Feil
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  5. H. Strasser
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  6. M. Kuczyk
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Correspondence to A. Stenzl.

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Stenzl, A., Anastasiadis, A.G., Corvin, S. et al. Vorteile der nerverhaltenden Beckenchirurgie. Urologe [A] 43, 141–150 (2004). https://doi.org/10.1007/s00120-003-0523-0

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