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Neurovascular bundle block as predictor of postoperative erectile function after radical prostatectomy

Abstract

We assessed audiovisually induced erections after nerve block of the neurovascular bundle during prostate biopsy. We evaluated neurovascular bundle nerve block to mimic non-nerve-sparing radical prostatectomy in an experimental setup. Patients undergoing a transrectal ultrasound-guided prostate biopsy were randomized to bilateral injection of 5 ml ropivacaine hydrochloride 0.75% or NaCl 0.9% into the neurovascular bundle. The patients completed the International Index of Erectile Function 5-item questionnaire (IIEF-5) questionnaire, and a detailed patient history was obtained. A routine prostate biopsy was performed. Thereafter, patients were exposed to 60 min of audiovisual stimulation. Erections were recorded using a Rigiscan-Plus™ device. A total of 11 patients were randomized. Five patients received NaCl (group 1) and six patients ropivacaine (group 2). Patient characteristics were comparable in terms of age (group 1: 59.8 y; group 2: 61.8 y), mean PSA (4.1 vs 4.7 ng/ml), mean IIEF-5 score (20.5 vs 22) and risk factors for erectile dysfunction, respectively. Patients of group 1 showed significantly stronger and longer erections after audiovisual stimulation than patients in group 2. Patients with bilateral infiltration of saline solution to the neurovascular bundle showed significantly stronger erections than patients receiving local anesthesia of the neurovascular bundle. Thus, this experiment might serve as a model to assess postoperative erectile function after a unilateral nerve-sparing radical prostatectomy.

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References

  1. Meyer JP et al. The effect of erectile dysfunction on the quality of life of men after radical prostatectomy. BJU Int 2003; 92: 929–931.

    Article  Google Scholar 

  2. Walsh PC, Donker PJ . Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982; 128: 492–497.

    CAS  Article  Google Scholar 

  3. Noldus J et al. Patient-reported sexual function after nerve-sparing radical retropubic prostatectomy. Eur Urol 2002; 42: 118–124.

    Article  Google Scholar 

  4. Kundu SD et al. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 2004; 172: 2227–2231.

    Article  Google Scholar 

  5. Stanford JL et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000; 283: 354–360.

    CAS  Article  Google Scholar 

  6. Walsh PC et al. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 2000; 55: 58–61.

    CAS  Article  Google Scholar 

  7. Rosen RC et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–326.

    CAS  Article  Google Scholar 

  8. Costello AJ, Brooks M, Cole OJ . Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int 2004; 94: 1071–1076.

    Article  Google Scholar 

  9. Gralnek D et al. Differences in sexual function and quality of life after nerve sparing and nonnerve sparing radical retropubic prostatectomy. J Urol 2000; 163: 1166–1169.

    CAS  Article  Google Scholar 

  10. Perczek RE et al. Facing a prostate cancer diagnosis: who is at risk for increased distress? Cancer 2002; 94: 2923–2929.

    Article  Google Scholar 

  11. Steginga SK et al. Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer. Urology 2004; 63: 751–756.

    Article  Google Scholar 

  12. Bisson JI et al. The prevalence and predictors of psychological distress in patients with early localized prostate cancer. BJU Int 2002; 90: 56–61.

    CAS  Article  Google Scholar 

  13. Mulhall JP, Graydon RJ . The hemodynamics of erectile dysfunction following nerve-sparing radical retropubic prostatectomy. Int J Impot Res 1996; 8: 91–94.

    CAS  PubMed  Google Scholar 

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Correspondence to R T Strebel.

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Strebel, R., Muentener, M., Fatzer, M. et al. Neurovascular bundle block as predictor of postoperative erectile function after radical prostatectomy. Int J Impot Res 17, 510–512 (2005). https://doi.org/10.1038/sj.ijir.3901345

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  • DOI: https://doi.org/10.1038/sj.ijir.3901345

Keywords

  • erectile dysfunction
  • penile tumescence
  • prostatectomy

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