Intraoperative Identification and Monitoring of the Somatic Nerves Critical to Potency Preservation during da Vinci Prostatectomy
Background
Since Walsh and Donker first introduced the anatomic nerve-sparing technique for retropubic radical prostatectomy1 (RRP) in the treatment of clinically localized prostate cancer, the importance of minimizing damage to the neurovascular bundle (NVB) has been recognized as a critical element for the preservation of potency and urinary continence post-prostatectomy. Although originally demonstrated in open prostatectomy procedures, sparing the NVB as described by Walsh, et al, has been shown to be equally, and in some reported literature, more effective in preserving potency and continence outcomes when the laparoscopic or robotic-assisted radical prostatectomy (RARP) approach is utilized.
Studies of pelvic neuro-anatomy, however, have taught us autonomic innervation is only half the story when it comes to potency and continence preservation. The other half of the story is the somatic nerves that typically lie outside of the NVB and innervate the levator ani muscle (LA), the external urethral sphincter (EUS), the bulbospongiosus muscle (BM) and the ischiocavernosus muscle (IM) (table 1), all critical for both potency and continence. Therefore, to maximize preservation of potency and continence a technique involving both preservation of the parasympathetic nerves contained in the NVB and preservation of the somatic nerves that lie outside the NVB must be employed.
-
Most popular related searches
Customer comments
No comments were found for Intraoperative Identification and Monitoring of the Somatic Nerves Critical to Potency Preservation during da Vinci Prostatectomy. Be the first to comment!