Klotz L, Herschorn S
Department of Surgery, University of Toronto, Sunnybrook Health Science Centre, Ontario, Canada.
Urology. 1998 Oct;52(4):537-42. doi: 10.1016/s0090-4295(98)00319-7.
To determine if intraoperative stimulation of the cavernous nerves while monitoring changes in penile tumescence to map the course of these nerves would result in an improvement in nerve sparing and erectile function after radical prostatectomy.
Patients were eligible for this pilot study if they were undergoing a radical prostatectomy and were candidates for a nerve-sparing approach. Erectile function was assessed by patient self-reporting and questionnaire before surgery and by patient self-reporting periodically 12 months after surgery. A cavernous nerve stimulator and tumescence-monitoring device was used during radical prostatectomy to identify the course of the cavernous nerves and guide the surgeon in avoiding nerve damage. Patients were monitored for any evidence of complications and/or adverse events for 1 year from time of surgery.
Twenty-six patients were recruited to the trial. Nerve stimulation and tumescence monitoring was performed in 23 patients. Twenty-one of 23 patients demonstrated a tumescence response to intraoperative nerve stimulation. Nineteen of 21 patients reported erectile function preoperatively. Seventeen (89%) of 19 patients demonstrated a tumescence response during surgery. Sixteen (94%) of the 17 patients who demonstrated a response to nerve stimulation and for whom the surgery was guided by the tumescence response reported the ability to have erections after surgery. No side effects due to the use of the device were reported. Only 3 (12%) of 25 patients had positive margins confined to the lateral margin and/or apex whose modifications associated with nerve sparing could conceivably have altered margin status.
These clinical data suggest that an intraoperative tumescence response to cavernous nerve stimulation may guide the surgeon in preserving cavernous nerves and improving erectile function after radical prostatectomy.
确定在监测阴茎勃起变化以绘制海绵体神经走行的同时，术中刺激海绵体神经是否会改善根治性前列腺切除术后的神经保留情况及勃起功能。
若患者正在接受根治性前列腺切除术且适合保留神经的手术方式，则符合本初步研究的条件。术前通过患者自我报告和问卷评估勃起功能，术后12个月定期通过患者自我报告进行评估。在根治性前列腺切除术中使用海绵体神经刺激器和勃起监测装置来确定海绵体神经的走行，并指导外科医生避免神经损伤。从手术时起对患者进行1年的并发症和/或不良事件监测。
26名患者被纳入该试验。23名患者进行了神经刺激和勃起监测。23名患者中有21名对术中神经刺激有勃起反应。21名患者中有19名术前报告有勃起功能。19名患者中有17名（89%）在手术期间有勃起反应。17名对神经刺激有反应且手术由勃起反应引导的患者中有16名（94%）报告术后有勃起能力。未报告因使用该装置产生的副作用。25名患者中只有3名（12%）的阳性切缘局限于外侧缘和/或尖部，其与保留神经相关的改变可能会改变切缘状态。
这些临床数据表明，术中对海绵体神经刺激的勃起反应可能会指导外科医生在根治性前列腺切除术后保留海绵体神经并改善勃起功能。
