Recker F, Meier T, Goepel M, Tscholl R
Urologische Klinik, Kantonsspital Aarau.
Urologe A. 1993 Sep;32(5):403-6.
Nine patients underwent retroperitoneal nerve-sparing lymph node dissection for bilateral nonseminomatous testicular tumours (path. St. I disease). While the isolated lumbar nerves L1, L2, L3 were electrostimulated (30 Hz, 5-20 V), the activity of these seminal vesicles, bladder neck and posterior urethra was recorded by way of suprapubic transvesical sonography and/or endoscopy. Emission started simultaneously on three different levels: contraction of the seminal vesicles in the periphery, bladder neck closure, and opening of the paracollicular space. Contraction of the seminal vesicles extends to the midline; the prostatic urethra closes, starting at the bladder neck. Secretion from the ductuli prostatici (milky) and from the ductucli ejaculatorii (transparent) follow. It was confirmed by the detection of PSA (11,000-21,000 ng/ml) in the ejaculate that prostatic secretion is also present in it. The significance of the postganglionic nerves for emission increased from L1 to L3. In three patients with salvage lymph node dissection the above-mentioned ultrasound monitoring allowed differentiate nerves relevant to emission from those not involved, allowing more comprehensive retroperitoneal resection.
9例双侧非精原细胞瘤性睾丸肿瘤（病理分期I期）患者接受了保留腹膜后神经的淋巴结清扫术。在对孤立的腰神经L1、L2、L3进行电刺激（30Hz，5 - 20V）时，通过耻骨上经膀胱超声检查和/或内窥镜检查记录这些精囊、膀胱颈和后尿道的活动。射精在三个不同水平同时开始：外周精囊收缩、膀胱颈关闭以及尿道旁间隙开放。精囊收缩延伸至中线；前列腺尿道从膀胱颈开始关闭。随后出现前列腺小导管（乳白色）和射精管（透明）的分泌。通过检测射精液中的PSA（11,000 - 21,000 ng/ml）证实其中也存在前列腺分泌。节后神经对射精的重要性从L1到L3逐渐增加。在3例接受挽救性淋巴结清扫术的患者中，上述超声监测能够区分与射精相关的神经和无关神经，从而实现更全面的腹膜后切除术。
