Department of Neuroscience, Neurophysiology, Uppsala University, Uppsala, Sweden Department of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden.
J Sex Med. 2013 Nov;10(11):2842-8. doi: 10.1111/j.1743-6109.2012.02892.x. Epub 2012 Aug 21.
Erectile dysfunction is a common side effect following radical prostatectomy mainly due to damage of the pelvic autonomic nerve fibers (cavernous nerves). Intraoperative electrical stimulation of the cavernous nerves while measuring changes in penile girth has previously been shown to provide the surgeon with feedback of nerve integrity.
To test the feasibility of recording changes in glans penis blood flow by Laser Doppler flowmetry from cavernous nerve stimulation.
Fifteen patients with localized prostate cancer undergoing radical prostatectomy had electrical stimulation of the proximal and distal parts of the neurovascular bundles after prostate removal. The stimulation consisted of 30-40 seconds biphasic constant current (10-30 mA) with 0.5 millisecond pulse duration.
Stimulus induced changes in penile blood flow was recorded from a Laser Doppler probe attached to the glans penis. Changes in penile girth were simultaneously recorded from a mercury-in rubber strain gauge. Erectile function was evaluated three months after surgery.
Ten patients had stimulus induced increase in Laser Doppler flow unilaterally (N=7) or bilaterally (N=3). Out of 10 patients, 6 reported some preserved erectile function postoperatively at 3 months follow-up (indicating 6 true and 4 false positives). Three patients had no Doppler response from stimulation and had no postoperative erectile function postoperatively (indicating three true negatives). Two patients were excluded from the study due to bad signal quality in the Laser Doppler signal. In the majority of patients, stimulation produced increase in penile girth sensed by the strain gauge.
This preliminary report provides evidence that Laser Doppler Flowmetry is able to detect increased penile blood flow from intraoperative electrical stimulation of the neurovascular bundles. However, further improvement in the recording technique is required. Laser Doppler Flowmetry may also be feasible to confirm autonomic nerve sparing in women undergoing pelvic surgery.
勃起功能障碍是根治性前列腺切除术后的常见副作用，主要是由于骨盆自主神经纤维（海绵体神经）损伤所致。术中测量阴茎周径变化时，对海绵体神经进行电刺激，已被证明可以为外科医生提供神经完整性的反馈。
测试通过激光多普勒血流仪从海绵体神经刺激记录龟头阴茎血流变化的可行性。
15 例局限性前列腺癌患者在根治性前列腺切除术后，在前列腺切除后对神经血管束的近端和远端进行电刺激。刺激包括 30-40 秒双相恒流（10-30mA），脉冲持续时间为 0.5 毫秒。
通过附着在龟头的激光多普勒探头记录刺激引起的阴茎血流变化。同时，通过汞-橡胶应变计记录阴茎周径的变化。术后 3 个月评估勃起功能。
10 例患者单侧（N=7）或双侧（N=3）激光多普勒血流出现刺激诱导增加。在 10 例患者中，6 例术后 3 个月随访时报告有一定程度的勃起功能保留（表示 6 例真阳性和 4 例假阳性）。3 例患者刺激后无多普勒反应，术后无勃起功能（表示 3 例真阴性）。由于激光多普勒信号质量差，2 例患者被排除在研究之外。在大多数患者中，刺激通过应变计产生阴茎周径增加。
本初步报告提供了证据，表明激光多普勒血流仪能够检测到术中对神经血管束进行电刺激后阴茎血流增加。然而，需要进一步改进记录技术。激光多普勒血流仪也可用于确认女性骨盆手术中自主神经保留。
