Nobuyuki Hinata1, Gen Murakami2, Hideaki Miyake3, Kazushi Tanaka3, Shin-ichi Abe4, Mineko Fujimiya5, Atsushi Takenaka6, Masato Fujisawa3. 1. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: hinata@med.kobe-u.ac.jp. 2. Department of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, Japan. 3. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. 4. Department of Anatomy, Tokyo Dental College, Chiba, Japan. 5. Department of Anatomy, Sapporo Medical University School of Medicine, Sappro, Japan. 6. Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
Abstract
OBJECTIVE: To investigate the hypothesis that preservation of the neurovascular bundle (NVB) contributes to the recovery from sphincter fatigue symptoms after robot-assisted radical prostatectomy (RARP) and to examine the sarcolemmal localization of neuronal nitric oxide synthase (nNOS) and nNOS-positive nerves supplying striated muscles in the pelvic floor. METHODS: Whether preservation of the NVB influences early continence or sphincter fatigue symptoms was examined in 211 consecutive patients undergoing RARP. Continence and sphincter fatigue symptoms were assessed at 1, 3, and 6 months after surgery. An anatomic study was performed using semiserial sections obtained from 14 male cadavers. The association of continence rate and sphincter fatigue symptoms with preservation of the NVB was assessed by the chi-square test. RESULTS: There was a significant difference across the bilateral, unilateral, and non-nerve-sparing groups with regard to sphincter fatigue symptoms at 1 month (P=.0004) and 3 months (P=.0326) postoperatively. Sarcolemmal nNOS was detected in the rhabdosphincter (mean, 0.57 per 10 muscle fibers) and levator ani (mean, 1.13 per 10 fibers), with fibers originating from periprostatic nNOS-positive nerves. CONCLUSION: Postoperative sphincter fatigue was reduced by NVB preservation, suggesting that decreased sphincter fatigue may contribute to improvement of continence after RARP. As a background, existence of sarcolemmal nNOS and nNOS-positive nerve terminals arising from the NVB was confirmed in male pelvic floor striated muscles.
OBJECTIVE: To investigate the hypothesis that preservation of the neurovascular bundle (NVB) contributes to the recovery from sphincter fatigue symptoms after robot-assisted radical prostatectomy (RARP) and to examine the sarcolemmal localization of neuronal nitric oxide synthase (nNOS) and nNOS-positive nerves supplying striated muscles in the pelvic floor. METHODS: Whether preservation of the NVB influences early continence or sphincter fatigue symptoms was examined in 211 consecutive patients undergoing RARP. Continence and sphincter fatigue symptoms were assessed at 1, 3, and 6 months after surgery. An anatomic study was performed using semiserial sections obtained from 14 male cadavers. The association of continence rate and sphincter fatigue symptoms with preservation of the NVB was assessed by the chi-square test. RESULTS: There was a significant difference across the bilateral, unilateral, and non-nerve-sparing groups with regard to sphincter fatigue symptoms at 1 month (P=.0004) and 3 months (P=.0326) postoperatively. Sarcolemmal nNOS was detected in the rhabdosphincter (mean, 0.57 per 10 muscle fibers) and levator ani (mean, 1.13 per 10 fibers), with fibers originating from periprostatic nNOS-positive nerves. CONCLUSION:Postoperative sphincter fatigue was reduced by NVB preservation, suggesting that decreased sphincter fatigue may contribute to improvement of continence after RARP. As a background, existence of sarcolemmal nNOS and nNOS-positive nerve terminals arising from the NVB was confirmed in male pelvic floor striated muscles.
Authors: M M Bertrand; B Alsaid; S Droupy; J Ripoche; G Benoit; P Adalian; C Brunet; M D Piercecchi-Marti; M Prudhomme Journal: Surg Radiol Anat Date: 2016-03-07 Impact factor: 1.246
Authors: Sean F Mungovan; Sigrid V Carlsson; Gregory C Gass; Petra L Graham; Jaspreet S Sandhu; Oguz Akin; Peter T Scardino; James A Eastham; Manish I Patel Journal: Nat Rev Urol Date: 2021-04-08 Impact factor: 14.432