Musci R, Franchini V, Strada G, De Cobelli O, Meroni T, Sala M, Rocco F
Clinica Urologica II, Università di Milano.
Arch Ital Urol Androl. 1994 Feb;66(1):5-10.
The technique for radical cystoprostatectomy was modified to avoid injury to the branches of pelvic plexus that innervate the corpora cavernosa (monolateral neurovascular bundle preservation or "Nerve sparing technique"). The studies of Walsh and coll. demonstrated that the branches of pelvic plexus that innervate the corpora cavernosa are situated between the rectum and urethra and penetrate the urogenital diaphragm near to the muscular wall of the urethra. Injuries to the pelvic plexus can occur during 1) division of posterior pedicle of bladder (the seminal vesicle can be used as a landmark intraoperatively to avoid injury to pelvic plexus), 2) during apical dissection of prostate with transection of the urethra. The return of sexual function postoperatively is related to preservation of autonomic innervation; the excision of the neurovascular bundle on one side may prevent impotence in 68% patients. Our study was undertaken to identify the cause of impotence in men undergoing radical cystoprostatectomy with "Nerve sparing technique" using bulbo cavernous reflex. Our results suggest that bulbo cavernosus reflex may not be a sensitive clinical tool to establish a diagnosis of neurogenic erectile dysfunction after pelvic surgery. The Authors examine the recent neuro-uro-physiological diagnostic methods for the study of neurogenic erectile dysfunction.
根治性膀胱前列腺切除术的技术进行了改良，以避免损伤支配海绵体的盆腔神经丛分支（单侧神经血管束保留或“神经保留技术”）。沃尔什等人的研究表明，支配海绵体的盆腔神经丛分支位于直肠和尿道之间，并在靠近尿道肌壁处穿透尿生殖膈。盆腔神经丛损伤可发生在以下情况：1）膀胱后蒂离断时（术中可将精囊用作标志以避免损伤盆腔神经丛）；2）前列腺尖部解剖及尿道横断时。术后性功能的恢复与自主神经支配的保留有关；单侧神经血管束切除可使68%的患者避免阳痿。我们的研究旨在利用球海绵体反射确定采用“神经保留技术”行根治性膀胱前列腺切除术的男性患者阳痿的原因。我们的结果表明，球海绵体反射可能不是盆腔手术后诊断神经源性勃起功能障碍的敏感临床工具。作者们探讨了用于研究神经源性勃起功能障碍的最新神经泌尿生理学诊断方法。
