Hansen M V, Ertekin C, Larsson L E, Pedersen K
Department of Urology, University Hospital, Linköping, Sweden.
Scand J Urol Nephrol. 1989;23(4):267-73. doi: 10.3109/00365598909180336.
24 men suffering from localized prostatic cancer undergoing radical retropubic nerve-sparing prostatectomy were investigated by the following electrophysiological methods: Bulbocavernosus reflexes elicited from the penile skin or the posterior urethra, sensory thresholds in the posterior urethra, cerebral evoked potentials after stimulation of the pudendal nerve or the posterior urethra. 15 men were examined 4-33 months postoperatively only, 5 men were examined only preoperatively and 4 men were examined both pre- and postoperatively. 10 men suffering from minor problems due to benign prostatic hyperplasia served as controls. In patients with localized cancer of the prostate, the findings did not differ from those in the control group. In the operated group the findings were pathological in a large proportion of the patients, indicating injuries both to nervous pathways running through the pelvic nerve plexus and in the pudendal nerve. The conclusions were: Localized cancer of the prostate has minimal or no risk at all of impaired functioning in the pelvic nervous pathways. Radical retropubic prostatectomy may in some cases be undertaken without any objective evidence of injury to these nervous pathways, but is often followed by findings indicating such injury. The dorsal nerve of the penis may be affected by the operation. Transcranial stimulation of the motor cortex is a useful method in the evaluation of prolonged or absent bulbocavernosus reflexes.
对24例接受耻骨后保留神经前列腺根治切除术的局限性前列腺癌患者，采用以下电生理方法进行研究：从阴茎皮肤或后尿道引出球海绵体反射、测定后尿道的感觉阈值、刺激阴部神经或后尿道后测定大脑诱发电位。15例患者仅在术后4 - 33个月接受检查，5例患者仅在术前接受检查，4例患者在术前和术后均接受检查。10例因良性前列腺增生有轻微问题的患者作为对照。在局限性前列腺癌患者中，检查结果与对照组无差异。在手术组中，大部分患者的检查结果呈病理性，表明穿过盆腔神经丛的神经通路和阴部神经均有损伤。结论如下：局限性前列腺癌对盆腔神经通路功能受损的风险极小或根本没有风险。耻骨后前列腺根治切除术在某些情况下可以在没有任何这些神经通路损伤的客观证据的情况下进行，但术后常常出现提示这种损伤的检查结果。阴茎背神经可能会受到手术影响。经颅刺激运动皮层是评估球海绵体反射延长或消失的一种有用方法。
