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Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision

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Abstract

Background

To improve nerve-sparing surgery, intraoperative electrical stimulation of pelvic autonomic nerves (INS) has been proposed in urology, gynecology, and visceral surgery. The aim of this study was to assess the impact of INS while monitoring intravesical pressure on the accurate evaluation of pelvic autonomic nerve preservation (PANP) after mesorectal excision. It was sought to determine whether this confirmation is useful in the prediction of postoperative urinary function.

Methods

Sixty-two patients with mesorectal exzision for rectal cancer were examined prospectively. PANP was assessed visually by the surgeon and with INS. Bladder function was evaluated by post voiding residual volume measurement, rate of recatheterization, rate of long-term urinary catheterisation, and the international prostatic symptom score with quality of life index.

Results

INS confirmed bilateral preservation of parasympathetic nerves in 46 patients (74%), and in 10 patients (16%) in at least one side. In six patients (10%), INS failed to confirm PANP. Eleven patients (18%) developed urinary symptoms postoperatively. INS results had a higher sensitivity than visual assessment by the surgeon (82 vs 46%). Values for specificity ranged at 90 and 92%, respectively. Accuracy of INS in predicting PANP was higher (88 vs 83%). The correlation between urinary function and the findings on INS was good (kappa-value: 0.65), correlation between urinary function and visual assessment by the surgeon was fair (kappa-value: 0.40).

Conclusion

INS, while monitoring intravesical pressure, accurately predicts bladder function after mesorectal excision. It may provide further insight into pelvic autonomic nerve sparing techniques.

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References

  1. Heald RJ (1997) Total mesorectal excision: history and anatomy of an operation. In: Soreide O, Norstein J (eds) Rectal cancer surgery: optimisation-standardisation-documentation. Springer, Berlin Heidelberg New York, pp 203–219

    Google Scholar 

  2. Enker WE, Havenga K, Thaler HT, Cohen AM, Polyak T, Cranor M, McDermott K (1997) Total mesorectal excision with pelvic autonomic nerve preservation in the operative treatment of rectal carcinoma. In: Soreide O, Norstein J (eds) Rectal cancer surgery: optimisation-standardisation-documentation. Springer, Berlin Heidelberg New York, pp 220–243

    Google Scholar 

  3. Havenga K, deRuiter MC, Enker WE, Welvaart K (1996) Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg 83:384–388

    Article  PubMed  CAS  Google Scholar 

  4. Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182:495–502

    PubMed  CAS  Google Scholar 

  5. Maurer CA (2005) Urinary and sexual function after total mesorectal excision. Recent Results Cancer Res 165:196–204

    PubMed  Google Scholar 

  6. Lue TF, Gleason CA, Brock GB, Carroll PR, Tanagho EA (1995) Intraoperative electrostimulation of the cavernous nerve: technique, results and limitations. J Urol 154:1426–1428

    Article  PubMed  CAS  Google Scholar 

  7. Kurokowa K, Suzuki T, Suzuki K, Terada N, Ito K, Yoshikawa D, Arai Y, Yamanaka H (2003) Preliminary results of a monitoring system to confirn the preservation of cavernous nerves. Int J Urol 10:136–140

    Article  Google Scholar 

  8. Hanna NN, Guillem J, Dosoretz A, Stekelman E, Minsky BD, Cohen AM (2002) Intraoperative parasympathetic nerve stimulation with tumescence monitoring during total mesorectal excision for rectal cancer. J Am Coll Surg 195:506–512

    Article  PubMed  Google Scholar 

  9. da Silva GM, Zmora O, Borjesson L, Mizhari N, Daniel N, Khandwala F, Efron J, Weiss EG, Nogueras JJ, Vernava AM 3rd, Wexner SD (2004) The efficacy of a nerve stimulator (CaverMap) to enhance autonomic nerve identification and confirm nerve preservation during total mesorectal excision. Dis Colon Rectum 47:2032–2038

    Article  PubMed  Google Scholar 

  10. Kneist W, Heintz A, Junginger T (2004) Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer. J Am Coll Surg 198:59–66

    Article  PubMed  Google Scholar 

  11. Kneist W, Junginger T (2004) Pelvic autonomic nerve stimulation during surgery for rectal cancer. Biomed Tech (Berl) 49(2):748–749

    Google Scholar 

  12. Kneist W, Junginger T (2005) Validity of pelvic autonomic nerve stimulation with intraoperative monitoring of bladder function following total mesorectal excision for rectal cancer. Dis Colon Rectum 48:262–269

    Article  PubMed  CAS  Google Scholar 

  13. Katahira A, Niikura H, Kaiho Y, Nakagawa H, Kurokawa K, Arai Y, Yaegashi N (2005) Intraoperative electrical stimulation of the pelvic splanchnic nerves during nerve-sparing radical hysterectomy. Gynecol Oncol 98:462–466

    Article  PubMed  CAS  Google Scholar 

  14. Mebust W, Roizo R, Schroeder F, Villers A (1997) Correlation between pathology, clinical symptoms and course of the disease. In: Cocket AT, Aso V, Chatelain C (eds) Proceeding of the international consultation on benign prostatic hyperplasia. WHO, Geneva, pp 51–62

    Google Scholar 

  15. Soreide O, Norstein J, Fielding LP, Silen W (1997) International standardisation and documentation of the treatment of rectal cancer. In: Soreide O, Norstein J (eds) Rectal cancer surgery. Optimisation–standardisation–documentation. Springer, Berlin Heidelberg New York, pp 405–445

    Google Scholar 

  16. Mancini R, Cosimelli M, Filippini A, Tedesco M, Pugliese P, Marcellini M, Pietrageli A, Lepiane P, Mascagni D, Cavaliere R, Di Matteo G (2000) Nerve-sparing surgery in rectal cancer: feasibility and functional results. J Exp Clin Cancer Res 19:35–40

    PubMed  CAS  Google Scholar 

  17. Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM (2000) Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 87:206–210

    Article  PubMed  CAS  Google Scholar 

  18. Kneist W, Heintz A, Wolf HK, Junginger T (2004) Die Darstellung autonomer Beckennerven bei partieller und totaler Mesorektumexzision. Einflussfaktoren und Bedeutung für die neurogene Blasenentleerungsstörung. Chirurg 75:276–283

    Article  PubMed  CAS  Google Scholar 

  19. Junginger T, Kneist W, Heintz A (2003) Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum 46:621–628

    Article  PubMed  CAS  Google Scholar 

  20. Baader B, Herrmann M (2003) Topography of pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat 16:119–130

    Article  PubMed  CAS  Google Scholar 

  21. Kneist W, Heintz A, Junginger T (2005) Major urinary dysfunction after mesorectal excision for rectal carcinoma. Br J Surg 92:230–234

    Article  PubMed  CAS  Google Scholar 

  22. Kaiho Y, Naagawa H, Ikeda, Y, Namiki S, Namuhata K, Satoh M, Saito S, Yoshimura K, Terai A, Ari Y (2005) Intraoperative electrophysiological confirmation of urinary continence after radical prostatectomy. J Urol 173:1139–1142

    Article  PubMed  Google Scholar 

  23. Junginger T, Kneist W, Borschitz T (2005) Totale Mesorektumexzision kann urogenitale Dysfunktion vermeiden. Dtsch Ärztebl 101:3106–3110

    Google Scholar 

  24. Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E (2002) A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 131:368–372

    Article  PubMed  Google Scholar 

  25. Michl U, Dietz R, Huland H (1999) Is intraoperative electrostimulation of erectile nerves possible? J Urol 162:1610–1613

    Article  PubMed  CAS  Google Scholar 

  26. Holzbeierlein J, Peterson M, Smith JA (2001) Variability of results of cavernous nerve stimulation during radical prostatectomy. J Urol 165:108–110

    Article  PubMed  CAS  Google Scholar 

  27. Chang SS, Peterson M, Smith J (2001) Intraoperative nerve stimulation predicts postoperative potency. Urology 58:594–597

    Article  PubMed  CAS  Google Scholar 

  28. Walsh PC, Marschke P, Catalona WJ, Lepor H, Martin S, Myers RP, Steiner MS (2001) Efficacy of first-generation Cavermap to verify location and function of cavernous nerves during radical prostatectomy: a multi-institutional evaluation by experienced surgeons. Urology 57:491–494

    Article  PubMed  CAS  Google Scholar 

  29. Kim HL, Stoffel DS, Mhoon DA, Brendler CB (2000) A positive caver map response poorly predicts recovery of potency after radical prostatectomy. Urology 56:561–564

    Article  PubMed  CAS  Google Scholar 

  30. Rehman J, Christ GJ, Kaynan A, Samadi D, Fleischmann J (1999) Intraoperative electrical stimulation of cavernosal nerves with monitoring of intracorporeal pressure in patients undergoing nerve sparing radical prostatectomy. BJU Int 84:305–310

    Article  PubMed  CAS  Google Scholar 

  31. Tereda N, Arai Y, Kurokawa K, Ohara H, Ichioka K, Matui Y, Yoshimura K, Yamanaka H, Terai A (2003) Intraoperative electrical stimulation of cavernous nerves with monitoring of intracorporeal pressure to confirm nerve sparing during radical prostatectomy: early clinical results. Int J Urol 10:251–256

    Article  Google Scholar 

  32. Kneist W, Junginger T (2004) Residual urine volume after total mesorectal excision: an indicator of pelvic autonomic nerve preservation? Results of a case-control study. Colorectal Dis 6:432–436

    Article  PubMed  CAS  Google Scholar 

  33. Klotz L, Heaton J, Jewett M, Chin J, Fleshner N, Goldberg L, Gleave M (2000) A randomized phase 3 study of intraoperative cavernous nerve stimulation with penile tumescence monitoring to improve nerve sparing during radical prostatectomy. J Urol 64:1573–1578

    Google Scholar 

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Acknowledgement

The authors thank Dr. Ing. K.P. Koch, Fraunhofer Institute for Biomedical Engineering St.Ingbert, Germany for fruitful discussion.

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  1. Clinic of General and Abdominal Surgery, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    W. Kneist & T. Junginger

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  1. W. Kneist
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  2. T. Junginger
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Correspondence to W. Kneist.

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Kneist, W., Junginger, T. Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision. Int J Colorectal Dis 22, 675–682 (2007). https://doi.org/10.1007/s00384-006-0203-9

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