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A neurophysiological study of patients undergoing radical prostatectomy
M V Hansen1, C Ertekin, L E Larsson
1Department of Urology, University Hospital, Linköping, Sweden.
Scandinavian Journal of Urology and Nephrology
|January 1, 1989
Summary
Radical retropubic prostatectomy for localized prostate cancer rarely impairs pelvic nerves. However, electrophysiological studies show a high incidence of nerve injury post-operation, particularly affecting the dorsal penile nerve.
Area of Science:
- Urology
- Neurophysiology
- Oncology
Background:
- Prostate cancer treatment can impact pelvic nerve function.
- Nerve-sparing prostatectomy aims to preserve neurological function.
- Electrophysiological assessment is crucial for evaluating nerve integrity.
Purpose of the Study:
- To investigate the impact of radical retropubic nerve-sparing prostatectomy on pelvic nerve function in men with localized prostate cancer.
- To differentiate between pre-operative nerve status in cancer patients and post-operative functional changes.
- To assess the utility of specific electrophysiological methods in detecting nerve damage.
Main Methods:
- Electrophysiological investigation including bulbocavernosus reflexes, sensory thresholds, and cerebral evoked potentials.
- Stimulation of penile skin, posterior urethra, and pudendal nerve.
- Comparison of findings in prostate cancer patients (pre- and post-operative) with a control group with benign prostatic hyperplasia.
Main Results:
- Localized prostate cancer itself did not show significant electrophysiological abnormalities compared to controls.
- A substantial proportion of operated patients exhibited pathological findings, indicating nerve pathway injuries.
- Injuries were observed in pelvic nerve plexus pathways and the pudendal nerve, with potential impact on the dorsal nerve of the penis.
Conclusions:
- Localized prostate cancer poses minimal risk to pelvic nerve function.
- Radical retropubic prostatectomy can lead to objective evidence of nerve injury, despite nerve-sparing techniques.
- Transcranial motor cortex stimulation is valuable for assessing bulbocavernosus reflex abnormalities post-surgery.