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Pathophysiology of Nerve Injury and Its Effect on Return of Erectile Function

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Urinary Continence and Sexual Function After Robotic Radical Prostatectomy

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Abstract

This chapter summarizes the basic anatomy and more importantly the pathophysiology of cavernous nerve injury and how our expanding knowledge of this topic will lead to future improvement of clinical outcomes.

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References

  1. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128(3):492–7.

    Google Scholar 

  2. Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate. 1983;4(5):473–85.

    Google Scholar 

  3. Seddon HJ, Medawar PB, Smith H. Rate of regeneration of peripheral nerves in man. J Physiol. 1943;102(2):191–215.

    Google Scholar 

  4. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–26.

    Google Scholar 

  5. Parsons JK, Marschke P, Maples P, Walsh PC. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology. 2004;64(5):987–90.

    Google Scholar 

  6. Hara I, Kawabata G, Miyake H, Nakamura I, Hara S, Okada H et al. Comparison of quality of life following laparoscopic and open prostatectomy for prostate cancer. J Urol. 2003;169(6):2045–8.

    Google Scholar 

  7. Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C et al. Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer. 2002;95(8):1773–85.

    Google Scholar 

  8. Rodriguez Jr E, Finley DS, Skarecky D, Ahlering TE. Single institution 2-year patient reported validated sexual function outcomes after nerve sparing robot assisted radical prostatectomy. J Urol. 2009;181(1):259–63.

    Google Scholar 

  9. Takenaka A, Murakami G, Matsubara A, Han SH, Fujisawa M. Variation in course of cavernous nerve with special reference to details of topographic relationships near prostatic apex: histologic study using male cadavers. Urology. 2005;65(1):136–42.

    Google Scholar 

  10. Takenaka A, Murakami G, Soga H, Jan SH, Arai Y, Fujisawa M. Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy. J Urol. 2004;172(3):1032–5.

    Google Scholar 

  11. Takenaka A, Kawada M, Murakami G, Hisasue S, Tsukamoto T, Fujisawa M. Interindividual variation in distribution of extramural ganglion cells in the male pelvis: a semi-quantitative and immunohistochemical study concerning nerve-sparing pelvic surgery. Eur Urol. 2005;48(1):46–52. discussion 52.

    Google Scholar 

  12. Dorland's medical dictionary 25th ed, p. 1534.

    Google Scholar 

  13. Alsaid B, Karam I, Bessede T, Abdlsamad I, Uhl JF, Delmas V et al. Tridimensional computer-assisted anatomic dissection of posterolateral prostatic neurovascular bundles. Eur Urol. 2010;58(2):281–7.

    Google Scholar 

  14. Tewari A, Peabody JO, Fischer, Sarle R, Vallancien G, Delmas V et al. An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003;43(5):444–54.

    Google Scholar 

  15. Tewari A, El-Hakim A, Horninger W, Peschel R, coll D, Bartsch G. Nerve-sparing during robotic radical prostatectomy: use of computer modeling and anatomic data to establish critical steps and maneuvers. Curr Urol Rep. 2005;6(2):126–8.

    Google Scholar 

  16. Costello AJ, Brooks M, Cole OJ. Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004;94(7):1071–6.

    Google Scholar 

  17. Ganzer R, Stolzenburg JU, Wieland WF, Brundl J. Anatomic study of periprostatic nerve distribution: immunohistochemical differentiation of parasympathetic and sympathetic nerve fibres. Eur Urol. 2012;62(6):1150–6.

    Google Scholar 

  18. Hall-Craggs ECB. Anatomy as a basis for clinical medicine. Munchen: Urban and Schwarzenberg; 1990.

    Google Scholar 

  19. Schaumburg HH, Zotova E, Cannella B, Raine CS, Arezzo J, Tar M et al. Structural and functional investigations of the murine cavernosal nerve: a model system for serial spatio-temporal study of autonomic neuropathy. BJU Int. 2007;99(4):916–24.

    Google Scholar 

  20. Donoff BR. Nerve regeneration: basic and applied aspects. Cirt Rev Oral Biol Med. 1995;6(1):18–24.

    Google Scholar 

  21. Bray GM, Aguayo AJ. Regeneration of peripheral unmyelinated nerves. Fate of the axonal sprouts which develop after injury. J Anat. 1974;117(Pt 3):517–29.

    Google Scholar 

  22. Ahlering TE, Eichel L, Skarecky D. Rapid communication: early potency outcomes with cautery-free neurovascular bundle preservation with robotic laparoscopic radical prostatectomy. J Endourol. 2005;19(6):715–8.

    Google Scholar 

  23. Ahlering TE, Eichel L, Chou D, Skarecky DW. Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation. Urology. 2005;65(5):994–7.

    Google Scholar 

  24. Ahlering TE, Skarecky D, Borin J. Impact of cautery versus cautery-free preservation of neurovascular bundles on early return of potency. J Endourol. 2006;20(8):586–9.

    Google Scholar 

  25. Ahlering TE, Eichel L, Skarecky D. Evaluation of long-term thermal injury using cautery during nerve sparing robotic prostatectomy. Urology. 2008;72(6):1371–4.

    Google Scholar 

  26. Wondergem J, Haveman J, Rusman V, Sminia P, Van Dijk JD. Effects of local hyperthermia on the motor function of the rat sciatic nerve. Int J Radiat Biol Relat Stud Phys Chem Med. 1988;53(3):429–38.

    Google Scholar 

  27. Hoogeveen JF, Troost D, Wondergem J, van der Kracht AH, Haveman J. Hyperthermic injury versus crush injury in the rat sciatic nerve: a comparative functional, histopathological and morphometrical study. J Neurol Sci. 1992;108(1):55–64.

    Google Scholar 

  28. Donzelli J, Leonetti JP, Wurster RD, Lee JM, Young MR. Neuroprotection due to irrigation during bipolar cautery. Arch Otolaryngol Head Neck Surg. 2000;126(2):149–53.

    Google Scholar 

  29. Ong AM, Su LM, Varkarakis I, Inagaki T, Link RE, Bhayani SB et al. Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. J Urol. 2004;172(4 Pt 1):1318–22.

    Google Scholar 

  30. Mandhani A, Dorsey PJ Jr., Ramanatha R, Salamanca JI, Rao S, Leung R et al. Real time monitoring of temperature changes in neurovascular bundles during robotic radical prostatectomy: thermal map for nerve-sparing radical prostatectomy. J Endourol. 2008;22(10):2313–7.

    Google Scholar 

  31. Khan F, Rodriquez E, Finley DS, Skarecky DW, Ahlering TE. Spread of thermal energy and heat sinks: implications for nerve-sparing robotic prostatectomy. J Endourol. 2007;21(10):1195–8.

    Google Scholar 

  32. Zorn KC, Bhojani N, Gautam G, Shikanov S, Gofrit ON, Jayram G et al. Application of ice cold irrigation during vascular pedicle control of robot-assisted radical prostatectomy: EnSeal instrument cooling to reduce collateral thermal tissue damage. J Endourol. 2010;24(12):1991–6.

    Google Scholar 

  33. Kowalczyk KJ, Huang AC, Hevelone ND, Lipsitz SR, Yu HY, Ulmer WD et al. Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes. Eur Urol. 2011;60(3):536–47.

    Google Scholar 

  34. Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol. 2012;62(3):368–81.

    Google Scholar 

  35. Finley DS, Rodriguez E Jr., Skarecky DW, Ahlering TE. Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: effect of unilateral vs bilateral nerve sparing. BJU Int. 2009;104(10):1484–9.

    Google Scholar 

  36. Walsh PC, Epstein JI, Lowe FC. Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle. J Urol. 1987;138(4):823–7.

    Google Scholar 

  37. Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172(6 Pt 1):2227–31.

    Google Scholar 

  38. Traish AM, Saad F, Feeley RJ, Guay A. The dark side of testosterone deficiency: III. Cardiovascular disease. J Androl. 2009;30(5):477–94.

    Google Scholar 

  39. Morales A. Andorgen deficiency in the aging male. In: Wein K et al., editors. Campbell-Walsh urology, Vol 1. 10th ed. Philadelphia, PA: Elsevier; 2012.

    Google Scholar 

  40. Ahlering TE, Morales B, Chang A, Skarecky D. Low free testosterone (FT) versus total testosterone (TT) in predicting potency following robotic-assisted radical prostatectomy. J Endourol. 2010;24(Suppl):A46, PS 6–24.

    Google Scholar 

  41. Ahlering TE, Morales B, Lusch A, Skarecky D. For preoperatively potent men free testosterone levels are predictive of time to potency following robotic-assisted radical prostatectomy. J Endourol. 2012;26(Suppl):A81–2.

    Google Scholar 

  42. Klein LT, Miller MI, Buttyan R, Raffo AJ, Burchard M, Devris G et al. Apoptosis in the rat penis after penile denervation. J Urol. 1997;158(2):626–30.

    Google Scholar 

  43. Rehman J, Ghrist GJ, Kaynan A, Samadi D, Fleischmann J. Intraoperative electrical stimulation of cavernosal nerves with monitoring of intracorporeal pressure in patients undergoing nerve sparing radical prostatectomy. BJU Int. 1999;84(3):305–10.

    Google Scholar 

  44. User HM, Hairston JH, Zelner DJ, McKenna KE, McVary KT. Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol. 2003;169(3):1175–9.

    Google Scholar 

  45. Leungwattanakij S, Bivalacqua TJ, Usta MF, Yang DY, Hyun JS, Champion HC et al. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl. 2003;24(2):239–45.

    Google Scholar 

  46. Mulhall JP, Slovick R, Hotaling J, Aviv N, Valenzuela R, Waters WB. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol. 2002;167(3):1371–5.

    Google Scholar 

  47. Montorsi F, Guazzoni G, Strambi LF, DaPozzo LF, Nava L, Barbieri L. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol. 1997;158(4):1408–10.

    Google Scholar 

  48. Zippe C. Early use of MUSE following radical prostatectomy facilitates earlier return of erectile function and successful sexual activity. Irvine, CA: A.R.T. Symposium, Editor; 2006.

    Google Scholar 

  49. Raina R, Agarwal A, Ausmundson S, Lakin M, Nandipati KC, Montague DK et al. Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int J Impot Res. 2006;18(1):77–81.

    Google Scholar 

  50. Padma-Nathan H et al. Postoperative nightly administration of sildenafil citrate significanty improves the return of normal spontaneous erectile function after bilateral nerve sparing radical prostatectomy. J Urol. 2003;169(Suppl):1402.

    Google Scholar 

  51. Padma-Nathan H, McCullough A, Forest C. Erectile dysfunction secondary to nerve-sparing radical retropubic prostatectomy: comparative phosphodiesterase-5 inhibitor efficacy for therapy and novel prevention strategies. Curr Urol Rep. 2004;5(6):467–71.

    Google Scholar 

  52. Schwartz EJ, Wong P, Graydon RJ. Sildenafil preserves intracorporeal smooth muscle after radical retropubic prostatectomy. J Urol. 2004;171(2 Pt 1):771–4.

    Google Scholar 

  53. Montorsi F, Brock G, Stolzenburg JU, Mulhall J, Moncada I, Patel HR et al. Effects of Tadalafil treatment on erectile function recovery following bilateral nerve-sparing radical prostatectomy: A randomized placebo-controlled study (REACTT). Eur Urol. 2014;65:587–96.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Urology, Rochester General Hospital, Rochester, NY, USA

    Louis Eichel M.D.

  2. Center for Urology, 2615 Culver Rd, Ste 100, Rochester, NY, 14609, USA

    Louis Eichel M.D.

  3. Department of Urology, Irvine Medical Center, University of California, Irvine, 333 The City Drive West, Suite 2100, RT 81, Orange, CA, 92868, USA

    Douglas Skarecky B.S. & Thomas E. Ahlering MD

Authors
  1. Louis Eichel M.D.
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  2. Douglas Skarecky B.S.
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  3. Thomas E. Ahlering MD
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Corresponding author

Correspondence to Thomas E. Ahlering MD .

Editor information

Editors and Affiliations

  1. International Robotic Prostatectomy Institute, Urology Center of Excellence at Jackson South Hospital, Miami, Florida, USA

    Sanjay Razdan

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Eichel, L., Skarecky, D., Ahlering, T.E. (2016). Pathophysiology of Nerve Injury and Its Effect on Return of Erectile Function. In: Razdan, S. (eds) Urinary Continence and Sexual Function After Robotic Radical Prostatectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-39448-0_4

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  • DOI: https://doi.org/10.1007/978-3-319-39448-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-39446-6

  • Online ISBN: 978-3-319-39448-0

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