DOCSLIB.ORG

Evoked Cavernous Activity: Neuroanatomic Implications

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read 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. Intact autonomic neural pathways are prerequisites In earlier studies, we showed the absence of for the vascular changes during erection and ECA in men with dysautonomias2 and in most men detumescence, with signals traveling through the after non-nerve-sparing radical pelvic surgery.4 The spinal cord tracts, the pelvic and hypogastric absence of ECA was interpreted as the disruption plexuses, and the cavernous nerves. Only a few of sympathetic innervation to the corpora, which tests exist to assess the autonomic components of was presumed to affect the erectile function. We genital innervation. One autonomic testing tech- conducted this study to further investigate the nique called evoked cavernous activity (ECA) autonomic innervation of the penis and the associa- measures intrapenile electrical activity after a brief tion to erectile function by using ECA to evaluate noxious stimulus. An applied noxious stimulus two groups of men with erectile dysfunction (ED): results in a generalized, sympathetic nervous system one cohort with ED from central nervous system discharge that manifests throughout the body, disruption due to spinal cord injury (SCI), and one including the corpus cavernosum.1,2 In healthy, group with peripheral (cavernous) nerve disruption potent men of varying ages, ECA is seen with due to pelvic surgery (PS). Our hypothesis was that consistent latency measurements.3 Although the either peripheral or central injury to the autonomic sympathetic discharge mediates corporal vaso- innervation to the penis would result in loss of constriction, and thus is anti-erectile, it is still a ECA. This result would be the basis from reflection of overall autonomic innervation. Further- which ECA could be used as a diagnostic test for neurogenic ED. Correspondence: Dr CC Yang, Department of Urology, University of Washington, Box 356510, Seattle, WA 98195- Methods 6510, USA. E-mail [email protected] After the study protocol approval by the Human Received 22 April 2009; revised 15 June 2009; accepted 15 Subjects Review Committee of our hospital, we June 2009; published online 16 July 2009 recruited seven men with complete thoracic SCI and ECA: neuroanatomic considerations U Yilmaz et al 302 Figure 1 (a) Diagram of evoked cavernous activity (ECA) reflex. Afferent signals travel through the median nerve to the CNS. The resultant sympathetic discharge is manifested throughout the body, including the erectile tissue. (b) Waveforms of ECA and sympathetic skin responses (SSRs) of a pelvic surgery patient in the pre-operative period. The stimulus is delivered at time 0 and the latency is measured between 0 and L, whereas the amplitudes are measured from the peak of the first deflection to the peak of the after (opposite) deflection. The time-base is 1 s per division, and the entire trace measures 10 s. sexual dysfunction, and six men who were scheduled If ECA was present after the first six stimuli, then for PS, specifically non-nerve-sparing radical cysto- no further stimuli were given. If ECA was not readily prostatectomy. All men in the PS group were sexually identifiable after all of the first six stimuli, then active preoperatively. Exclusion criteria for all groups more stimuli were delivered, up to a total of 12. included moderate to severe cardiovascular disease, The latency was measured at the first deflection diabetes mellitus, untreated hypertension, current from baseline after the stimulus delivery, and drug or alcohol abuse, major psychiatric disorder, amplitude measurements were made peak to peak. and unwillingness or inability to complete the Three responses were averaged for final latency questionnaire. Except for spinal cord injury, there and amplitude values. Sympathetic skin responses was no evidence of other neurological disease. (SSRs) were measured simultaneously from the Each participant underwent a history and hand and foot contralateral to the median nerve physical examination, with a detailed urological stimulus. SSRs are slow wave recordings that are and neurological examination of extremities and temporally related to ECA and share similar wave- genitalia. forms (Figure 1). These responses were recorded as a All participants completed the International In- control for the presence of a generalized sympa- dex of Erectile Function (IIEF) questionnaire5 before thetic discharge. Latency and amplitude measure- ECA testing. In the PS group, ECA was performed ments of the SSRs from the hand and foot were preoperatively and at the third post-operative month measured in a standard manner.6 visit. Statistical analyses ECA testing The groups were compared using the Kruskal– The electrodiagnostic technique for ECA was pre- Wallis and Mann–Whitney U-tests. In the PS group, viously described.2–4 Briefly, a noxious stimulus the parameters were also compared between the was delivered to the median nerve on the left wrist pre-operative and post-operative periods using the from a Viking IV electrophysiology machine (Viasys Wilcoxon test. Healthcare, Madison, WI, USA) with the participant in the supine position. The stimulus amplitude was 5–7 mA, duration 0.5 ms, and delivered at irregular Results intervals of at least 60 s in to avoid habituation. ECA was recorded from both corpora cavernosa through All participants tolerated the procedure well. concentric 28-gauge gold-plated needle electrodes Average age of the SCI group was younger than the ± ± (20-mm long, 0.4-mm diameter, Nicolet Biomedical PS group (34.7 7.6 years vs 59.1 5.6 years, Inc., WI, USA) placed into the corpora at the lateral Po0.001). aspects at the base of the penis, with the tip of the electrodes positioned in the center of each corporal body. The band-pass filters were set to 0.5–100 Hz. A IIEF ground plate was affixed to the skin overlying the The results of the erectile domain of the IIEF were right anterior/superior iliac crest. tabulated (Table 1). The post-operative PS IIEF and International Journal of Impotence Research ECA: neuroanatomic considerations U Yilmaz et al 303 Table 1 Mean ECA amplitude and latency measurements PS group (n ¼ 6) SCI group (n ¼ 7) Preoperative Postoperative Mean (s.d.) Mean (s.d.) Mean (s.d.) Latency (ms) Right ECA 1841 (405) 2212.2 (1100) No response Left ECA 1842 (437) 1725 (185) No response Hand SSR 1692 (184) 1675 (360) 1716 (170) Foot SSR 2071 (98) 2577 (1383) No response Amplitude (mV) Right ECA 295 (140) 493 (592) No response Left ECA 288 (238) 451 (577) No response Hand SSR 2670 (2366) 1763 (854) 2793 (2187) Foot SSR 1658 (1136) 1870 (1298) No response IIEF, erectile domain (total possible score ¼ 30) 16.3 (5.6) 5.6 (6.5) 10.7 (10.3) Abbreviations: ECA, evoked cavernous activity; IIEF, International Index of Erectile Function; PS, pelvic surgery group; SCI, spinal cord injury; SSR, sympathetic skin response. Figure 2 Evoked cavernous activity (ECA) in patient with spinal cord injury. (a) Diagram of disrupted ECA reflex and (b) ECA waveforms. Note the absence of activity in both corpora cavernosa and foot sympathetic skin response (SSR). Deflections off the baseline before 1 s in the right ECA and foot SSR trace are artefact. Stimulus is delivered at time 0. The time-base is 1 s per division, and the entire trace measures 10 s. Amplitude sensitivities are set higher than those in Figure 1. SCI IIEF scores were not statistically different from dry skin, and thus ECA was not recordable. None each other (P ¼ 0.268). of the individuals with SCI had foot SSRs or ECA (Figure 2). ECA All the PS patients had reproducible ECA and SSRs, Discussion both preoperatively and postoperatively (Figure 1). There was no difference in the latency and ampli- Evoked cavernous activity is a measure of sympa- tude measurements of ECA and SSRs in the post- thetic (autonomic) discharge in the erectile tissue of operative compared with that of the pre-operative the penis. In this study, we examined the measure- period (Table 1, P40.05). Both pre-operative and ments in men with ED due to central nervous system post-operative values were within the normal disruption from spinal cord injury, and men with ED limits.3 Despite the reported loss of erectile function due to peripheral (cavernous) nerve disruption after in the post-surgery group, there was not a corres- radical pelvic surgery.
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]
  • 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.
    [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]