González Javier, Hernández Emilio
Servicio de Urología, Hospital Universitario de Getafe, Madrid, España.
Arch Esp Urol. 2011 Apr;64(3):156-67.
Although radical prostatectomy is a curative therapy that has proven effective in many of our patients with prostate cancer, it is still associated with significant morbidity, which includes postoperative erectile dysfunction among its leading exponents. Potency after the intervention may be influenced by many factors, among which, presence of adequate erectile function before surgery, patient's age, stage of disease at the time of treatment, surgeon's experience and, of course, interpersonal anatomical variations may be pointed out. In recent decades, the exact knowledge of the neuroanatomy of the male pelvis has become very important, for both the student of human anatomy and the pelvic surgeon. Therefore, the anatomical nerve sparing techniques have led to fewer complications related to the injury of these structures. This article presents a brief description of the neuroanatomical substrate of the neurovascular bundles along with a detailed compilation of the different surgical techniques for their preservation during radical retropubic prostatectomy.
尽管根治性前列腺切除术是一种已被证明对许多前列腺癌患者有效的治愈性疗法,但它仍伴有显著的发病率,其中术后勃起功能障碍是主要表现之一。干预后的性功能可能受多种因素影响,其中可指出的因素包括手术前是否存在足够的勃起功能、患者年龄、治疗时疾病的分期、外科医生的经验,当然还有个体解剖变异。近几十年来,对于男性盆腔神经解剖学的确切了解,对人体解剖学学生和盆腔外科医生而言都变得非常重要。因此,解剖学上保留神经的技术已减少了与这些结构损伤相关的并发症。本文简要描述了神经血管束的神经解剖学基础,并详细汇编了耻骨后根治性前列腺切除术中保留它们的不同手术技术。