DOCSLIB.ORG

Erectile Dysfunction Following Radical Prostatectomy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Erectile Dysfunction Following Radical Prostatectomy Downloaded from www.jama.com at Johns Hopkins University, on November 23, 2005 GRAND ROUNDS CLINICIAN’S CORNER AT THE JOHNS HOPKINS BAYVIEW MEDICAL CENTER Erectile Dysfunction Following Radical Prostatectomy Arthur L. Burnett, MD Erectile dysfunction following radical prostatectomy for clinically localized pros- CASE PRESENTATION tate cancer is a known potential complication of the surgery. Because pros- DR BURNETT: Mr G is a previously tate cancer is diagnosed today more frequently than in the past and because healthy 51-year-old man who works as the diagnosis is made in increasingly younger men, there is an urgent need to a health program administrator. Dur- develop effective interventions that preserve erectile function after surgery. ing a prostate health screening, he was In this presentation, a 51-year-old man with adenocarcinoma of the prostate found to have a prostate-specific anti- underwent a bilateral nerve-sparing radical prostatectomy, after which he lost gen (PSA) level of 4.2 ng/mL (normal natural erectile function for approximately 9 months. The case highlights the range: 0.0-4.0 ng/mL). On digital rec- tal examination, the prostate was of av- fact that following surgery in which the nerve-sparing radical prostatectomy erage size and without nodules or technique is used, between 60% to 85% of men eventually recover erectile masses. A urological consultation was function. This constitutes a dramatic improvement over an earlier era, when recommended. postprostatectomy erectile dysfunction was the nearly universal rule. The case Mr G underwent a transrectal ultra- also emphasizes that despite expert application of the nerve-sparing prosta- sound-guided biopsy of the prostate tectomy technique, early recovery of natural erectile function is uncommon. gland. There were no sonographic ab- Many patients experience erectile dysfunction for as long as 2 years after the normalities, but the 12-core biopsy es- procedure, requiring the use of erectile aids for sexual activity during this pe- tablished the diagnosis of adenocarci- noma, with a Gleason score of 6 (see riod until natural erections recover. Corrective, cause-specific advances such TABLE 1 for explanation of Gleason as neuromodulatory therapy offer valuable adjuncts to this surgery. score).1,2 The cancer involved 80% of a JAMA. 2005;293:2648-2653 www.jama.com single core from the right base region of the prostate. Because Mr G was judged to have a low risk for metastatic dis- used cigarettes. He was taking nutri- agnosis and how you arrived at a deci- ease, further imaging studies were not tional supplements that included saw sion about your treatment? indicated. He was counseled regarding palmetto, fish oil, and various vita- MR G: I was stunned when first told management options for his diagnosis mins. To his knowledge, no one in his that I had cancer. I never, ever expected of clinically localized prostate cancer. family had ever been diagnosed with that diagnosis. I thought I was in great I saw Mr G for the first time about 5 prostate cancer. We reviewed his physical shape, doing all the right things weeks later for a second opinion. His clinical presentation and workup, to live a long, happy life. Before meet- vital signs were within normal limits. which was consistent with an early ing Dr Burnett, I had actually done a con- In fact, he appeared quite fit, with a stage prostate cancer of intermediate siderable amount of study about pros- body mass index of 24 (Յ25 consis- grade. We next discussed applicable tate cancer. I had explored the different tent with healthy weight). He stated that management options, including sur- Author Affiliations: Johns Hopkins University School he experienced no urinary complaints veillance (watchful waiting); radical of Medicine, Department of Urology, The James and his erectile function was fully in- prostatectomy; radiation therapy ad- Buchanan Brady Urological Institute, The Johns Hop- ministered by external beam and/or in- kins Medical Institutions, Baltimore, Md. tact, as evidenced by a score of 25 Corresponding Author: Arthur L. Burnett, MD, De- (range: 0-25) on the Sexual Health In- terstitial implants; and cryotherapy partment of Urology, The Johns Hopkins Hospital, 600 3 (freezing the prostate). We reviewed the N Wolfe St, Marburg 407, Baltimore, MD 21287- ventory for Men (SHIM). He had never 2411 ([email protected]). advantages and disadvantages of each Grand Rounds at The Johns Hopkins Bayview Medi- option. cal Center Section Editors: John H. Stone, MD, MPH, Charles Weiner, MD, Stephen D. Sisson, MD, The Johns CME available online at DR BURNETT: Mr G, could you please www.jama.com Hopkins Hospital, Baltimore, Md; David S. Cooper, MD, tell us about your reaction to your di- Contributing Editor, JAMA. 2648 JAMA, June 1, 2005—Vol 293, No. 21 (Reprinted) ©2005 American Medical Association. All rights reserved. Downloaded from www.jama.com at Johns Hopkins University, on November 23, 2005 ERECTILE DYSFUNCTION FOLLOWING RADICAL PROSTATECTOMY treatment options and felt certain I on my own! It is a wonderful thing. (His Table 1. Explanation of the Gleason Score* should have my prostate removed. Sur- 12-month postoperative SHIM score Biopsy gery seemed to offer the best chance for was 18.) Aggressiveness Level Incidence, % a cure, and since I am a young man, I fa- Low 2 vored a treatment that would give me the DISCUSSION Gleason 2 (1 ϩ 1) Gleason 3 (1 ϩ 2) best chance for living a lot longer. But Mr G’s case illustrates several key con- Gleason 4 (2 ϩ 2) the notion that I might lose erectile func- cepts in the current management of pros- Intermediate 70 Gleason 5 (2 ϩ 3-3ϩ 2) tion was still devastating. Fortunately, my tate cancer. Among solid-organ malig- Gleason 6 (3 ϩ 3) wife was very supportive. I’m not sure nancies, prostate cancer is the most Intermediate-High 20 how I would have moved forward with- commonly diagnosed tumor and the sec- Gleason 7 (3 ϩ 4) Gleason 7 (4 ϩ 3) out her. I recall her saying: “I don’t have ond-leading cause of cancer-related High 8 a relationship with your penis. I have a deaths among men in the United States.4 Gleason 8 (4 ϩ 4) Gleason 9 (4 ϩ 5-5ϩ 4) relationship with you.” Mr G’s presentation typifies some of the Gleason 10 (5 ϩ 5) DR BURNETT: Mr G opted for radical common dilemmas facing many pa- *The pathological patterns of prostate cancer range from prostatectomy, which was performed tients diagnosed today with this dis- 1 (almost normal-looking) to 5 (very poorly differenti- ated). The Gleason system of evaluating prostate can- successfully 1 year ago. We used a bi- ease. Our improved diagnostic capabili- cer is based on this range with grades termed for these 5 specific patterns of cancer-cell architecture. The score lateral cavernous nerve-sparing tech- ties have led to the fact that many prostate refers to the addition of the numbers of the first and sec- nique at surgery to maximize his like- cancer patients receive their diagnoses at ond most common patterns. Note that the grouping for “intermediate-high” aggressiveness includes 2 biologi- lihood of erection preservation. The final relatively young ages. In considering the cally distinct tumors for Gleason 7, with score 4 ϩ 3=7 pathology confirmed the presence of or- impact of the various treatment ap- behaving more aggressively than score 3 ϩ 4=7.1,2 gan-confined prostate cancer with nega- proaches on their quality of life, many tive surgical margins, pelvic lymph patients place paramount importance on several weeks, return of urinary conti- nodes, and seminal vesicles, consistent the possibility of retaining natural erec- nence is achieved by more than 95% of with disease eradication. No adjuvant tile function.5 This matter is frequently patients within a few months, and erec- therapy was indicated. Serial PSA mea- important to young men who by age sta- tion recovery with ability to engage in surements every 3 months since sur- tus are more likely to have intact erec- sexual intercourse is regained by most gery confirmed undetectable levels. tile function than older men; however, patients with or without oral phospho- DR BURNETT: Mr G, how did you fare for all men having normal preoperative diesterase type 5 (PDE 5) inhibitors with your recovery? erectile function irrespective of age, pres- within 2 years.7 It is acknowledged that MR G: I did great with the surgery. I ervation of this function is understand- these expectations reflect results was back at work within a few weeks. ably important postoperatively. achieved at major academic centers, I was continent of urine in 1 month and Although radical prostatectomy has which may not be representative of the 27 days! (I am told that this is rather been referred to as the gold standard for patterns of care experienced by most quick for the recovery of continence.) definitive cure of early stage prostate men treated for localized prostate can- But I was concerned by my lack of erec- cancer, this option has been chal- cer in the United States. tions. I know Dr Burnett explained that lenged frequently in recent years, prin- Regardless of clinical practice set- erection recovery could take as much cipally over questions related to the ting, the reality of the recovery pro- as 2 years, but I felt the pressure. The degree of functional recovery in many cess after radical prostatectomy today, pressure was not from my wife; I had areas. Historically, radical prostatec- nonetheless, is that erectile function re- my own pressure as a man. I was the tomy has carried high risks of postop- covery lags behind other functional re- one who really wanted something to be erative complications, including covery in other areas.
Load more

Recommended publications
  • How to Ensure Clitoral Bud Survival in a Sexual Reassignment Surgery for Transsexualism
    How We Do It J Cosmet Med 2018;2(1):57-62 https://doi.org/10.25056/JCM.2018.2.1.57 pISSN 2508-8831, eISSN 2586-0585 How to ensure clitoral bud survival in a sexual reassignment surgery for transsexualism Juthapot Pumsup, MD Juthapot Clinics,Trad, Thailand Background: Sexual reassignment surgery (SRS) is the complicated procedure as it has a very high risk of complications. The loss of clitoris is the ones. Accordingly, surgeons should carefully consider the surgical technique and ensure no mistakes during operation. Although most surgeons perform the operation carefully, a considerable incidence of clitoral bud necrosis has been reported. Thus, finding techniques that improve the success rates in surgeries is very important. Objective: We aimed to study the cause of neo-clitoral bud necrosis after SRS in order to devise a mechanism to avoid neo-clitoral bud necrosis, and to find a surgical technique for ensuring the survival of the clitoral bud. Methods: The study was conducted in 20 patients, who underwent a male-to-female SRS via Author technique From Juthapot Clinics, Trad Hospital, and Private Hospital (couldn’t mention) during September 2016 to August 2017. This intervention included various factors as mention below. Results: Of the 20 patients who underwent the procedure with this technique, 18 patients were without clitoral bud necrosis and 2 patients had partial clitoral bud necrosis at the tip. Sensation was preserved in these patients, although it was decreased. The sensation has 2 part: the 1st part is neoclitoris and the 2nd is at the anterior vagina, that made by the urethral lining after spatulation, that can serve the sensation.
    [Show full text]
  • Unit #2 - Abdomen, Pelvis and Perineum
    UNIT #2 - ABDOMEN, PELVIS AND PERINEUM 1 UNIT #2 - ABDOMEN, PELVIS AND PERINEUM Reading Gray’s Anatomy for Students (GAFS), Chapters 4-5 Gray’s Dissection Guide for Human Anatomy (GDGHA), Labs 10-17 Unit #2- Abdomen, Pelvis, and Perineum G08- Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) G09A- Peritoneum, GI System Overview and Foregut (Dr. Albertine) G09B- Arteries, Veins, and Lymphatics of the GI System (Dr. Albertine) G10A- Midgut and Hindgut (Dr. Albertine) G10B- Innervation of the GI Tract and Osteology of the Pelvis (Dr. Albertine) G11- Posterior Abdominal Wall (Dr. Albertine) G12- Gluteal Region, Perineum Related to the Ischioanal Fossa (Dr. Albertine) G13- Urogenital Triangle (Dr. Albertine) G14A- Female Reproductive System (Dr. Albertine) G14B- Male Reproductive System (Dr. Albertine) 2 G08: Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) At the end of this lecture, students should be able to master the following: 1) Overview a) Identify the functions of the anterior abdominal wall b) Describe the boundaries of the anterior abdominal wall 2) Surface Anatomy a) Locate and describe the following surface landmarks: xiphoid process, costal margin, 9th costal cartilage, iliac crest, pubic tubercle, umbilicus 3 3) Planes and Divisions a) Identify and describe the following planes of the abdomen: transpyloric, transumbilical, subcostal, transtu- bercular, and midclavicular b) Describe the 9 zones created by the subcostal, transtubercular, and midclavicular planes c) Describe the 4 quadrants created
    [Show full text]
  • Award Winning Paper Ð Tanagho Prize Signi®Cant Physiological
    International Journal of Impotence Research (2001) 13, 82±88 ß 2001 Nature Publishing Group All rights reserved 0955-9930/01 $15.00 www.nature.com/ijir Award Winning Paper Ð Tanagho Prize Signi®cant physiological roles of ancillary penile nerves on increase in intracavernous pressure in rats: experiments using electrical stimulation of the medial preoptic area YSato1, J Rehman1, C Santizo1, A Melman1, and GJ Christ1;2* 1Department of Urology, Institute for Smooth Muscle Biology, Albert Einstein College of Medicine, New York, USA; and 2Department of Physiology and Biophysics, Institute for Smooth Muscle Biology, Albert Einstein College of Medicine, New York, USA The objectives of this work were to evaluate the contributions of the ancillary penile nerves to penile erection in male rats in vivo. We investigated the effects of unilateral and bilateral transection of the cavernous nerve (main penile nerve) on the increase in intracavernous pressure (ICP) following electrical stimulation of the medial preoptic area (MPOA) in male rats in vivo. After unilateral or bilateral transection of the cavernous nerve (main penile nerve), the ICP responses showed decreases of 28% and 55%, respectively compared to those ICP responses before transection. In other words, even after bilateral transection of the cavernous nerve, signi®cant increases in the ICP response following central stimulation were observed. In contrast to these ®ndings, the ICP response was completely eliminated following bilateral pelvic nerve transection. These data suggested that the ancillary penile nerves, which originate from the major pelvic ganglia, have a complementary role to the cavernous nerves in the autonomic motor innervation of the penis.
    [Show full text]
  • Specific Targeting of Ganglion Cell Sprouts Provides an Additional
    The Journal of Neuroscience, October 1, 1998, 18(19):7987–7995 Specific Targeting of Ganglion Cell Sprouts Provides an Additional Mechanism for Restoring Peripheral Motor Circuits in Pelvic Ganglia after Spinal Nerve Damage Mark E. Kepper and Janet R. Keast Department of Physiology and Pharmacology, The University of Queensland, St. Lucia, Queensland, 4072, Australia The pelvic ganglia contain both sympathetic and parasympa- which grow profusely within just a few days. These arise from thetic neurons and provide an interesting model in which to each of the main chemical classes of pelvic neurons but grow study the effects of a distributed spinal nerve lesion. Previous at different rates and have different distributions. Importantly, animal studies have suggested that after either lumbar or sacral some chemical classes of sprouts preferentially supply neurons nerve injury, some functional connections are restored between of dissimilar histochemistry, suggesting the presence of very preganglionic and postganglionic neurons. It has been pro- specific targeting mechanisms rather than random growth. posed that this is because of intact preganglionic axons sprout- These sprouts are transient, however, those formed after partial ing collaterals to supply denervated ganglion cells. However, decentralization appear to be maintained. Moreover, after le- this has never been demonstrated, and our study has investi- sion of either lumbar or sacral spinal nerves, many sprouts arise gated whether the ganglion cells themselves contribute to axo- from neurons with intact spinal connections and innervate neu- genesis and restoration of peripheral circuitry. We have moni- rons that have lost their preganglionic inputs. This provides a tored the growth of axons from pelvic ganglion cells after very different alternative mechanism to reestablish communi- lumbar or sacral nerve injury (partial decentralization), or a cation between preganglionic and postganglionic neurons.
    [Show full text]
  • Plasticity of Neurons in Mouse Major Pelvic Ganglia in Response to Loss of Physiological
    Plasticity of neurons in mouse major pelvic ganglia in response to loss of physiological input in cases of nerve injury and spinal cord injury A Dissertation Presented to The Faculty of the Graduate School At the University of Missouri In Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy By Cindy Kyi Dr. David Schulz, Dissertation Advisor May 2018 i The undersigned, appointed by the dean of the Graduate School, have examined the dissertation entitled PLASTICITY OF NEURONS IN MOUSE MAJOR PELVIC GANGLIA IN RESPONSE TO LOSS OF PHYSIOLOGICAL INPUT IN CASES OF NERVE INJURY AND SPINAL CORD INJURY Presented by Kyi, Cindy (MU-Student) A candidate for the degree of Doctor of Philosophy And hereby certify that, in their opinion, it is worthy of acceptance. Dr. David J. Schulz Dr. Michael L. Garcia Dr. Andrew D. McClellan Dr. Kevin J. Cummings Dedicated to Mom and Dad iii ACKNOWLEDGEMENTS First of all, I would like to thank God for guiding me and being with me and my family since the day I left Myanmar (Burma). He has been my rock and shelter through all the challenges along the way. I am very grateful to my advisor Dr. David Schulz for granting me with the opportunity to work in his laboratory and believing in me to take on a new project. Thank you very much for all your guidance, patience, training, and for giving me room to grow under your mentorship. I would also like to thank my committee members Dr. Andrew McClellan, Dr. Michael Garcia, and Dr. Kevin Cummings for all of their support in providing me with feedback not only on the details of experimental protocols but also helping me relate my experimental findings to a big picture context.
    [Show full text]
  • IX. Neurology
    IX. Neurology THE NERVOUS SYSTEM is the most complicated and highly organized of the various systems which make up the human body. It is the 1 mechanism concerned with the correlation and integration of various bodily processes and the reactions and adjustments of the organism to its environment. In addition the cerebral cortex is concerned with conscious life. It may be divided into two parts, central and peripheral. The central nervous system consists of the encephalon or brain, contained within the cranium, and the medulla spinalis or spinal 2 cord, lodged in the vertebral canal; the two portions are continuous with one another at the level of the upper border of the atlas vertebra. The peripheral nervous system consists of a series of nerves by which the central nervous system is connected with the various tissues of the body. For descriptive purposes these nerves may be arranged in two groups, cerebrospinal and sympathetic, the arrangement, however, being an arbitrary one, since the two groups are intimately connected and closely intermingled. Both the cerebrospinal and sympathetic nerves have nuclei of origin (the somatic efferent and sympathetic efferent) as well as nuclei of termination (somatic afferent and sympathetic afferent) in the central nervous system. The cerebrospinal nerves are forty-three in number on either side—twelve cranial, attached to the brain, and thirty-one spinal, to the medulla spinalis. They are associated with the functions of the special and general senses and with the voluntary movements of the body. The sympathetic nerves transmit the impulses which regulate the movements of the viscera, determine the caliber of the bloodvessels, and control the phenomena of secretion.
    [Show full text]
  • Sympathetic Pathways and Adrenergic Innervation of the Penis
    International Journal of Impotence Research (2000) 12, Suppl 1, S5±S12 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir BASIC SCIENCE RESEARCH Sympathetic pathways and adrenergic innervation of the penis K-E Andersson1*, P Hedlund1 and P Alm2 1Department of Clinical Pharmacology, University of Lund, Lund University Hospital, Lund, Sweden; 2Department of Pathology, University of Lund, Lund University Hospital, Lund, Sweden; The sympathetic nervous system is important for penile function: it mediates detumescence and may contribute to the maintenance of the penis in a non-erect state. The sympathetic preganglionic neurons are found in the intermediolateral gray matter of the spinal cord. Postganglionic neurons are located to the sympathetic chain ganglia, the inferior mesenteric, hypogastric and pelvic ganglia, and possibly to ganglia near the target organ. Sympathetic ®bres can be found in the pelvic, cavernous, and pudendal nerves. Stimulation of the sympathetic pathways to the penis may, however, also produce erection. It has been suggested that the suprasacral vasodilator pathway is a sympathetic cholinergic pathway, operating through cholinergic neurons in the pelvic plexus. In the penis, there is a rich sympathetic, adrenergic innervation of the corpus cavernosum (CC) and the vasculature, and in particular of the helicine arteries. Sympathetic, adrenergic nerves also contain neuropeptide Y. Parasympathetic cholinergic nerves, which mediate CC relaxation and erection, contain not only acetylcholine, but also vasoactive intestinal polypeptide, nitric oxide synthase, and probably other mediators and=or mediator-synthesizing enzymes. Activation of sympathetic adrenergic nerves causes release of noradrenaline, acting on a-adrenoceptors in the trabecular smooth muscle of the CC and in penile vessels.
    [Show full text]
  • Autonomic Nervous System of the Pelvis — General Overview
    FOLIA MEDICA CRACOVIENSIA Vol. LVIII, 2, 2018: 21–44 PL ISSN 0015-5616 DOI: 10.24425/fmc.2018.124656 Autonomic nervous system of the pelvis — general overview Justyna Sienkiewicz-Zawilińska1, Jarosław Zawiliński1, Lourdes Niroya Kaythampillai1, Marcin Jakiel1, Jacenty Urbaniak1, Tomasz Bereza1, Wojciech Kowalski2, Marios Loukas3, Jerzy Walocha1 1Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland 2Gabinety Lekarskie Wojciech Kowalski, Kraków, Poland 3Department of Anatomy, St. George’s University, Grenada Corresponding author: Jerzy A. Walocha, MD, PhD Department of Anatomy, Jagiellonian University Medical College ul. Kopernika 12, 31-034 Kraków, Poland Phone: +48 12 422 95 11; E-mail: [email protected] Abstract: Autonomic nervous system of the pelvis is still poorly understood. Every year more and more pelvic procedures are carried out on patients suff ering from diff erent pelvic disorders what leads to numerous pelvic dysfunctions. Authors tried to review, starting from historical and clinical background, the most important reports on anatomy of the pelvic autonomic plexuses. We also pay attention to complete lack of knowledge of students of medicine on the autonomic nervous structures in the area studied. We present anatomical description of the pelvic plexuses including their visceral branches and anatomy of surrounding pelvic tissues which still remains unclear. More and more attention is paid to the topography of the plexuses specially because of new pain releasing techniques — neurolysies. Key words: autonomic nervous system, inferior hypogastric plexus, anatomy, nerve sparing, pelvis. 22 Justyna Sienkiewicz-Zawilińska, Jarosław Zawiliński, et al. Introduction Th e innervation of human pelvis was a subject of numerous studies and reports of the scientists who studied both fresh and embalmed cadavers (Hunter, Lee, Beck, Frankenhäuser, Davis, Labate, Krantz, Quinn).
    [Show full text]
  • Pelvic Autonomic Nerve Mapping Around the Prostate by Intraoperative Electrical Stimulation with Simultaneous Measurement of Intracavernous and Intraurethral Pressure
    Pelvic Autonomic Nerve Mapping Around the Prostate by Intraoperative Electrical Stimulation With Simultaneous Measurement of Intracavernous and Intraurethral Pressure Atsushi Takenaka,* Ashutosh Tewari, Rouei Hara, Robert A. Leung, Kohei Kurokawa, Gen Murakami and Masato Fujisawa From the Departments of Urology, Weill Medical College of Cornell University (AT, AT, RAL), New York, New York, and Kawasaki Medical School (RH), Kurashiki and Takasaki National Hospital (KK), Takasaki, and Department of Anatomy, Sapporo Medical University (GM), Sapporo and Division of Urology, Department of Organ Therapeutics, Kobe University Graduate School of Medicine (AT, MF), Kobe, Japan Purpose: In previous studies we noted that the neurovascular bundle was not identical to the bundle of the cavernous nerve fibers. In this study we sought to prove these anatomical findings electrophysiologically and map the autonomic nerve fibers by intraoperative simultaneous measurement of intracavernous pressure and intraurethral pressure. Materials and Methods: Between January 2004 and May 2005 electrical stimulation was performed in 27 open pelvic surgeries, including 26 radical retropubic prostatectomies and 1 radical cystectomy, using an original bipolar electrode before prostate removal. Nerve stimulation was performed at the base of the so-called neurovascular bundle (point A) and the rectal wall about 1 cm posterolateral, apart from the neurovascular bundle (point B). Intracavernous pressure and intraurethral pressure were measured simultaneously. Ϯ Ϯ Ϯ Results: The mean SD increase in intracavernous pressure was 9.8 6.3 cm H2O at point A and 13.5 7.3 cm H2Oat point B. Intracavernous pressure at point B was significantly higher than at point A (p ϭ 0.0240). The mean increase in Ϯ Ϯ intraurethral pressure was 17.0 9.4 cm H2O at point A and 11.2 8.1 cm H2O at point B.
    [Show full text]
  • Establishment of the Autonomic Neuroanatomy to the Vulval Erectile Tissues
    ESTABLISHMENT OF THE AUTONOMIC NEUROANATOMY TO THE VULVAL ERECTILE TISSUES by SHONA MARIE LOUISE PENHALE B.Sc, The University of British Columbia, 2000 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQU1RMENTS FOR THE DEGREE OF MASTERS OF SCIENCE in FACULTY OF GRADUATE STUDIES (DEPARTMENT OF ANATOMY) We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 2003 © Shona Marie Louise Penhale UBC Rare Books and Special Collections - Thesis Authorisation Form Page 1 of 1 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada http://www.library.ubc.ca/spcoll/thesauth.html 07/10/2003 ABSTRACT Erectile tissues are the vascular structures within the vulva that fill with blood and are an integral component of the woman's sexual response. Despite the importance of these structures to her sexual function, the detailed neuroanatomical pathways of the autonomic nerves underlying this mechanism of vascular congestion, have not been elucidated. Therefore, this research had been designed to identify the missing components to answer the question: "What is the pathway of the nerves running from the female pelvic plexus to the external genitalia?".
    [Show full text]
  • Nerve Graft to Restore Erectile Function During Radical Prostatectomy
    UnitedHealthcare® Oxford Clinical Policy Nerve Graft to Restore Erectile Function During Radical Prostatectomy Policy Number: SURGERY 043.19 T2 Effective Date: January 1, 2021 Instructions for Use Table of Contents Page Related Policies Coverage Rationale ....................................................................... 1 None Applicable Codes .......................................................................... 1 Description of Services ................................................................. 1 Clinical Evidence ........................................................................... 2 U.S. Food and Drug Administration ............................................. 4 References ..................................................................................... 5 Policy History/Revision Information ............................................. 5 Instructions for Use ....................................................................... 6 Coverage Rationale Autologous (e.g. sural) or allogenic nerve grafts to restore erectile function during or after radical prostatectomy are unproven and not medically necessary due to insufficient evidence of efficacy. Applicable Codes The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan
    [Show full text]
  • Evoked Cavernous Activity: Neuroanatomic Implications
    International Journal of Impotence Research (2009) 21, 301–305 & 2009 Nature Publishing Group All rights reserved 0955-9930/09 $32.00 www.nature.com/ijir ORIGINAL ARTICLE Evoked cavernous activity: neuroanatomic implications U Yilmaz1, B Vicars1 and CC Yang1,2 1Department of Urology, University of Washington, Seattle, WA, USA and 2VA Puget Sound Healthcare System, Seattle, WA, USA We investigated the autonomic innervation of the penis by using evoked cavernous activity (ECA). We recruited seven men with thoracic spinal cord injury (SCI) and sexual dysfunction, and six men who were scheduled to have pelvic surgery (PS), specifically non-nerve-sparing radical cystoprostatectomy. In the PS patients, ECA was performed both pre- and postoperatively. The left median nerve was electrically stimulated and ECA was recorded with two concentric electromyography needles placed into the right and left cavernous bodies. We simultaneously recorded hand and foot sympathetic skin responses (SSRs) as controls. In the SCI group, all but one patient had reproducible hand SSRs. None of these patients had ECA or foot SSRs. All the PS patients had reproducible ECA and SSRs, both preoperatively and postoperatively. There was no difference in the latency and amplitude measurements of ECA and SSRs in the postoperative compared with that of the pre-operative period (P40.05). In conclusion, ECA is absent in men with SCI above the sympathetic outflow to the genitalia. In men, after radical pelvic surgery, ECA is preserved, indicating the preservation of sympathetic fibers. International Journal of Impotence Research (2009) 21, 301–305; doi:10.1038/ijir.2009.34; published online 16 July 2009 Keywords: ECA; autonomic nerve; electrodiagnostic test; erectile dysfunction; penis Introduction more, there are no direct measures of parasym- pathetic function for the penis.
    [Show full text]