Campbell Jeffrey D, Alenezi Husain, DeYoung Ling X, Brock Gerald B, Pautler Stephen E
Department of Surgery, Division of Urology, Western University, London, Ontario, Canada.
Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Surgical Oncology, Department of Oncology, Western University, London, Ontario, Canada.
Sex Med. 2019 Mar;7(1):104-110. doi: 10.1016/j.esxm.2018.11.006. Epub 2019 Jan 21.
Postoperative erectile dysfunction (ED) remains a prevalent consequence of radical prostatectomy (RP) that significantly impacts patient quality of life. Water-jet technology is widely used for dissection in neurosurgical procedures but novel to urologic surgery.
To establish the impact of hydro-jet dissection (HJD) of the cavernous nerves (CN) on postoperative erectile function in an animal model of RP-induced ED.
32 male Sprague-Dawley rats were randomized to 4 groups: Sham surgery (n = 8), bilateral HJD of CN (n = 8), blunt CN injury (n = 8), or stretch CN injury (n = 8). After 4 weeks, erectile function was assessed by measuring intracavernous pressure (ICP), and penile tissues were harvested for immunohistologic studies.
The peak ICP and the area under the curve were calculated for each group. Immunohistologic studies were performed for α-smooth muscle actin and neuronal nitric oxide synthase on cross-sections of penile tissue.
Rats in the HJD group demonstrate a significantly higher mean peak ICP and area under the curve compared with both CN injury groups (P = .001). Postoperative erectile function in the HJD group returned to baseline function. Preservation of α-smooth muscle actin and neuronal nitric oxide synthase was observed in the HJD group compared with the other surgical trauma groups.
Hydro-jet dissection used in an RP animal model maintains erectile function and offers a potential benefit that warrants further human studies.
STRENGTHS & LIMITATIONS: This is a novel animal study comparing a new technology to established CN dissection techniques. This study uses an animal model, which may not completely translate to post-RP ED in humans.
Hydro-jet dissection of the CN during RP in an animal model is associated with significantly better postoperative erectile function when compared with other CN injury. Clinical studies are needed to further investigate the putative benefit of HJD on erectile function in patients undergoing RP. Campbell JD, Alenezi H, DeYoung LX, et al. Hydrojet Dissection of the Cavernous Nerves Preserves Erection Function in a Radical Prostatectomy Animal Model. Sex Med 2019;7:104-110.
术后勃起功能障碍（ED）仍然是根治性前列腺切除术（RP）常见的后果，对患者生活质量有显著影响。水刀技术在神经外科手术中广泛用于解剖，但在泌尿外科手术中尚属新颖。
在RP诱导的ED动物模型中，确定海绵体神经（CN）水刀解剖（HJD）对术后勃起功能的影响。
32只雄性Sprague-Dawley大鼠随机分为4组：假手术组（n = 8）、双侧CN的HJD组（n = 8）、钝性CN损伤组（n = 8）或牵拉CN损伤组（n = 8）。4周后，通过测量海绵体内压（ICP）评估勃起功能，并采集阴茎组织进行免疫组织学研究。
计算每组的峰值ICP和曲线下面积。对阴茎组织切片进行α-平滑肌肌动蛋白和神经元型一氧化氮合酶的免疫组织学研究。
与两个CN损伤组相比，HJD组大鼠的平均峰值ICP和曲线下面积显著更高（P = .001）。HJD组术后勃起功能恢复至基线功能。与其他手术创伤组相比，HJD组观察到α-平滑肌肌动蛋白和神经元型一氧化氮合酶得以保留。
在RP动物模型中使用水刀解剖可维持勃起功能，并提供了潜在益处，值得进一步开展人体研究。
这是一项将新技术与既定的CN解剖技术进行比较的新颖动物研究。本研究使用动物模型，可能无法完全类推至人类RP后的ED情况。
与其他CN损伤相比，在动物模型的RP过程中对CN进行水刀解剖与术后显著更好的勃起功能相关。需要开展临床研究以进一步探究HJD对接受RP患者勃起功能的假定益处。坎贝尔JD、阿莱内齐H、德扬LX等。根治性前列腺切除动物模型中海绵体神经的水刀解剖可保留勃起功能。性医学2019；7：104 - 110。
