Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible
High local stage prostate and bladder cancers frequently require wide local resection and sacrifice of one or both cavernous nerves to achieve a negative surgical margin, thus resulting in erectile dysfunction. This is a report on preliminary experience with cavernous nerve graft reconstruction usin...
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Veröffentlicht in: | Prostate cancer and prostatic diseases 2003-03, Vol.6 (1), p.56-60 |
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creator | Anastasiadis, A G Benson, M C Rosenwasser, M P Salomon, L El-Rashidy, H Ghafar, M A McKiernan, J M Burchardt, M Shabsigh, R |
description | High local stage prostate and bladder cancers frequently require wide local resection and sacrifice of one or both cavernous nerves to achieve a negative surgical margin, thus resulting in erectile dysfunction. This is a report on preliminary experience with cavernous nerve graft reconstruction using sural nerve grafts with radical prostatectomy or radical cystectomy.
Pre-operative evaluation was performed and consent was obtained in 14 potent men with prostate (11) or bladder (three) cancer. Sural nerve grafts of resected cavernous nerves were performed using a microsurgical technique. Post-operative treatment (Sildenafil or Alprostadil) was pursued until return of spontaneous function, documented by interview and adequate scores (>20) in the erectile function (EF) domain of the International Index of Erectile Function (IIEF).
Twelve unilateral nerve grafts were performed, 10 during radical prostatectomy and two during radical cystoprostatectomy. Two procedures were technically not possible because of locally advanced disease. Mean age was 57.5 y (36–68 y). Mean follow up was 16.1 months (7–28 months). Pathological stage of prostate cancer was pT2 in 2, pT3 in 7 and pT4 in one. Surgical margins were positive in five out of 10 (50%), and two (20%%) had positive lymph nodes. Four patients (three post prostatectomy and one post cystectomy) were fully potent. Additionally, one patient post prostatectomy had improving partial erections. Six patients post prostatectomy and one patient post cystectomy had no erections. The only complication was one superficial wound infection in the sural nerve donor site.
Preliminary experience shows that sural nerve grafts are feasible and safe after radical prostatectomy and cystectomy. However, candidates usually present with high stage disease, high risk for recurrence and frequent requirement for adjuvant therapy that further compromises erectile function. Randomized studies with more patients and long follow-up periods are necessary in order to define the ideal candidate for nerve graft procedures. |
doi_str_mv | 10.1038/sj.pcan.4500613 |
format | Article |
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Pre-operative evaluation was performed and consent was obtained in 14 potent men with prostate (11) or bladder (three) cancer. Sural nerve grafts of resected cavernous nerves were performed using a microsurgical technique. Post-operative treatment (Sildenafil or Alprostadil) was pursued until return of spontaneous function, documented by interview and adequate scores (>20) in the erectile function (EF) domain of the International Index of Erectile Function (IIEF).
Twelve unilateral nerve grafts were performed, 10 during radical prostatectomy and two during radical cystoprostatectomy. Two procedures were technically not possible because of locally advanced disease. Mean age was 57.5 y (36–68 y). Mean follow up was 16.1 months (7–28 months). Pathological stage of prostate cancer was pT2 in 2, pT3 in 7 and pT4 in one. Surgical margins were positive in five out of 10 (50%), and two (20%%) had positive lymph nodes. Four patients (three post prostatectomy and one post cystectomy) were fully potent. Additionally, one patient post prostatectomy had improving partial erections. Six patients post prostatectomy and one patient post cystectomy had no erections. The only complication was one superficial wound infection in the sural nerve donor site.
Preliminary experience shows that sural nerve grafts are feasible and safe after radical prostatectomy and cystectomy. However, candidates usually present with high stage disease, high risk for recurrence and frequent requirement for adjuvant therapy that further compromises erectile function. Randomized studies with more patients and long follow-up periods are necessary in order to define the ideal candidate for nerve graft procedures.</description><identifier>ISSN: 1365-7852</identifier><identifier>EISSN: 1476-5608</identifier><identifier>DOI: 10.1038/sj.pcan.4500613</identifier><identifier>PMID: 12664067</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Adult ; Aged ; Biomedicine ; Bladder ; Bladder cancer ; Cancer Research ; Cancer surgery ; Care and treatment ; Complications and side effects ; Cystectomy - methods ; Erectile dysfunction ; Grafting ; Grafts ; Health aspects ; Health risks ; Humans ; Impotence ; Lymph nodes ; Male ; Middle Aged ; Nerves ; Neural cell transplants ; Neurosurgical Procedures ; Patients ; Penile Erection ; Penis - innervation ; Prostate ; Prostate cancer ; Prostatectomy ; Prostatectomy - methods ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Risk factors ; Sildenafil ; Sural nerve ; Sural Nerve - transplantation ; Treatment Outcome ; Urinary Bladder Neoplasms - pathology ; Urinary Bladder Neoplasms - surgery ; Urologic Surgical Procedures, Male - adverse effects ; Urologic Surgical Procedures, Male - methods ; Urological surgery ; Wound infection</subject><ispartof>Prostate cancer and prostatic diseases, 2003-03, Vol.6 (1), p.56-60</ispartof><rights>Springer Nature Limited 2003</rights><rights>COPYRIGHT 2003 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group 2003</rights><rights>Nature Publishing Group 2003.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-5429aa73b720c9ff477a4da3fbff0f753d7ff97382e41593c4d5b1639afb8b7e3</citedby><cites>FETCH-LOGICAL-c487t-5429aa73b720c9ff477a4da3fbff0f753d7ff97382e41593c4d5b1639afb8b7e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/sj.pcan.4500613$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/sj.pcan.4500613$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12664067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Anastasiadis, A G</creatorcontrib><creatorcontrib>Benson, M C</creatorcontrib><creatorcontrib>Rosenwasser, M P</creatorcontrib><creatorcontrib>Salomon, L</creatorcontrib><creatorcontrib>El-Rashidy, H</creatorcontrib><creatorcontrib>Ghafar, M A</creatorcontrib><creatorcontrib>McKiernan, J M</creatorcontrib><creatorcontrib>Burchardt, M</creatorcontrib><creatorcontrib>Shabsigh, R</creatorcontrib><title>Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible</title><title>Prostate cancer and prostatic diseases</title><addtitle>Prostate Cancer Prostatic Dis</addtitle><addtitle>Prostate Cancer Prostatic Dis</addtitle><description>High local stage prostate and bladder cancers frequently require wide local resection and sacrifice of one or both cavernous nerves to achieve a negative surgical margin, thus resulting in erectile dysfunction. This is a report on preliminary experience with cavernous nerve graft reconstruction using sural nerve grafts with radical prostatectomy or radical cystectomy.
Pre-operative evaluation was performed and consent was obtained in 14 potent men with prostate (11) or bladder (three) cancer. Sural nerve grafts of resected cavernous nerves were performed using a microsurgical technique. Post-operative treatment (Sildenafil or Alprostadil) was pursued until return of spontaneous function, documented by interview and adequate scores (>20) in the erectile function (EF) domain of the International Index of Erectile Function (IIEF).
Twelve unilateral nerve grafts were performed, 10 during radical prostatectomy and two during radical cystoprostatectomy. Two procedures were technically not possible because of locally advanced disease. Mean age was 57.5 y (36–68 y). Mean follow up was 16.1 months (7–28 months). Pathological stage of prostate cancer was pT2 in 2, pT3 in 7 and pT4 in one. Surgical margins were positive in five out of 10 (50%), and two (20%%) had positive lymph nodes. Four patients (three post prostatectomy and one post cystectomy) were fully potent. Additionally, one patient post prostatectomy had improving partial erections. Six patients post prostatectomy and one patient post cystectomy had no erections. The only complication was one superficial wound infection in the sural nerve donor site.
Preliminary experience shows that sural nerve grafts are feasible and safe after radical prostatectomy and cystectomy. However, candidates usually present with high stage disease, high risk for recurrence and frequent requirement for adjuvant therapy that further compromises erectile function. Randomized studies with more patients and long follow-up periods are necessary in order to define the ideal candidate for nerve graft procedures.</description><subject>Adult</subject><subject>Aged</subject><subject>Biomedicine</subject><subject>Bladder</subject><subject>Bladder cancer</subject><subject>Cancer Research</subject><subject>Cancer surgery</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Cystectomy - methods</subject><subject>Erectile dysfunction</subject><subject>Grafting</subject><subject>Grafts</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Humans</subject><subject>Impotence</subject><subject>Lymph nodes</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nerves</subject><subject>Neural cell transplants</subject><subject>Neurosurgical Procedures</subject><subject>Patients</subject><subject>Penile Erection</subject><subject>Penis - innervation</subject><subject>Prostate</subject><subject>Prostate cancer</subject><subject>Prostatectomy</subject><subject>Prostatectomy - methods</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Risk factors</subject><subject>Sildenafil</subject><subject>Sural nerve</subject><subject>Sural Nerve - transplantation</subject><subject>Treatment Outcome</subject><subject>Urinary Bladder Neoplasms - pathology</subject><subject>Urinary Bladder Neoplasms - surgery</subject><subject>Urologic Surgical Procedures, Male - adverse effects</subject><subject>Urologic Surgical Procedures, Male - methods</subject><subject>Urological surgery</subject><subject>Wound infection</subject><issn>1365-7852</issn><issn>1476-5608</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1ksuL2zAQh01p6W63PfdWRAt7S1Zv2b0toS9Y6KU9i7E8ShxsOZXsQP77ysQ03dJFB4mZb16aX1G8ZXTNqCjv0n59cBDWUlGqmXhWXDNp9EppWj7Pb6HVypSKXxWvUtpTSitW0ZfFFeNaS6rNdXHcwBFjGKZEAsYjkm0EP5KIbghpjJMb2yGQZopt2JIITeugI4c4pBFGdOPQn8gQ_zjcKS3WjySBRwKhIdmyC7O7OxGPkNq6w9fFCw9dwjfLfVP8_Pzpx-br6uH7l2-b-4eVk6UZV0ryCsCI2nDqKu-lMSAbEL72nnqjRGO8r4woOUqmKuFko2qmRQW-LmuD4qa4PefNLf-aMI22b5PDroOAeWZrBJNcCZPBD_-A-2GKIfdmuZZKcGY4y9T7JylOWSlZqS-pttChbYMfxghurmvvWVlxzpWSmVr_h8qnwb7Nn4--zfZHAbd_BewQunGXhm6aF5Qeg3dn0OU1pYjeHmLbQzxZRu2sGpv2dlaNXVSTI94tY011j82FX2SSAXoG0mEWAsbL3E_l_A1uIM5D</recordid><startdate>20030301</startdate><enddate>20030301</enddate><creator>Anastasiadis, A G</creator><creator>Benson, M C</creator><creator>Rosenwasser, M P</creator><creator>Salomon, L</creator><creator>El-Rashidy, H</creator><creator>Ghafar, M A</creator><creator>McKiernan, J M</creator><creator>Burchardt, M</creator><creator>Shabsigh, R</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20030301</creationdate><title>Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible</title><author>Anastasiadis, A G ; Benson, M C ; Rosenwasser, M P ; Salomon, L ; El-Rashidy, H ; Ghafar, M A ; McKiernan, J M ; Burchardt, M ; Shabsigh, R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-5429aa73b720c9ff477a4da3fbff0f753d7ff97382e41593c4d5b1639afb8b7e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biomedicine</topic><topic>Bladder</topic><topic>Bladder cancer</topic><topic>Cancer Research</topic><topic>Cancer surgery</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Cystectomy - 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methods</topic><topic>Urological surgery</topic><topic>Wound infection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Anastasiadis, A G</creatorcontrib><creatorcontrib>Benson, M C</creatorcontrib><creatorcontrib>Rosenwasser, M P</creatorcontrib><creatorcontrib>Salomon, L</creatorcontrib><creatorcontrib>El-Rashidy, H</creatorcontrib><creatorcontrib>Ghafar, M A</creatorcontrib><creatorcontrib>McKiernan, J M</creatorcontrib><creatorcontrib>Burchardt, M</creatorcontrib><creatorcontrib>Shabsigh, R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Prostate cancer and prostatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Anastasiadis, A G</au><au>Benson, M C</au><au>Rosenwasser, M P</au><au>Salomon, L</au><au>El-Rashidy, H</au><au>Ghafar, M A</au><au>McKiernan, J M</au><au>Burchardt, M</au><au>Shabsigh, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible</atitle><jtitle>Prostate cancer and prostatic diseases</jtitle><stitle>Prostate Cancer Prostatic Dis</stitle><addtitle>Prostate Cancer Prostatic Dis</addtitle><date>2003-03-01</date><risdate>2003</risdate><volume>6</volume><issue>1</issue><spage>56</spage><epage>60</epage><pages>56-60</pages><issn>1365-7852</issn><eissn>1476-5608</eissn><abstract>High local stage prostate and bladder cancers frequently require wide local resection and sacrifice of one or both cavernous nerves to achieve a negative surgical margin, thus resulting in erectile dysfunction. This is a report on preliminary experience with cavernous nerve graft reconstruction using sural nerve grafts with radical prostatectomy or radical cystectomy.
Pre-operative evaluation was performed and consent was obtained in 14 potent men with prostate (11) or bladder (three) cancer. Sural nerve grafts of resected cavernous nerves were performed using a microsurgical technique. Post-operative treatment (Sildenafil or Alprostadil) was pursued until return of spontaneous function, documented by interview and adequate scores (>20) in the erectile function (EF) domain of the International Index of Erectile Function (IIEF).
Twelve unilateral nerve grafts were performed, 10 during radical prostatectomy and two during radical cystoprostatectomy. Two procedures were technically not possible because of locally advanced disease. Mean age was 57.5 y (36–68 y). Mean follow up was 16.1 months (7–28 months). Pathological stage of prostate cancer was pT2 in 2, pT3 in 7 and pT4 in one. Surgical margins were positive in five out of 10 (50%), and two (20%%) had positive lymph nodes. Four patients (three post prostatectomy and one post cystectomy) were fully potent. Additionally, one patient post prostatectomy had improving partial erections. Six patients post prostatectomy and one patient post cystectomy had no erections. The only complication was one superficial wound infection in the sural nerve donor site.
Preliminary experience shows that sural nerve grafts are feasible and safe after radical prostatectomy and cystectomy. However, candidates usually present with high stage disease, high risk for recurrence and frequent requirement for adjuvant therapy that further compromises erectile function. Randomized studies with more patients and long follow-up periods are necessary in order to define the ideal candidate for nerve graft procedures.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>12664067</pmid><doi>10.1038/sj.pcan.4500613</doi><tpages>5</tpages></addata></record> |
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subjects | Adult Aged Biomedicine Bladder Bladder cancer Cancer Research Cancer surgery Care and treatment Complications and side effects Cystectomy - methods Erectile dysfunction Grafting Grafts Health aspects Health risks Humans Impotence Lymph nodes Male Middle Aged Nerves Neural cell transplants Neurosurgical Procedures Patients Penile Erection Penis - innervation Prostate Prostate cancer Prostatectomy Prostatectomy - methods Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Risk factors Sildenafil Sural nerve Sural Nerve - transplantation Treatment Outcome Urinary Bladder Neoplasms - pathology Urinary Bladder Neoplasms - surgery Urologic Surgical Procedures, Male - adverse effects Urologic Surgical Procedures, Male - methods Urological surgery Wound infection |
title | Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible |
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