scholarly journals Justification of vacuum prophylaxis as part of the penile rehabilitation in patients after nerve-sparing radical prostatectomy

2021 ◽  
Vol 9 (4) ◽  
pp. 87-94
Author(s):  
A. E. Osadchinskiy ◽  
I. S. Pavlov ◽  
S. V. Kotov
Keyword(s):  
Radical Prostatectomy ◽  
Erectile Function ◽  
Venous Blood ◽  
Nerve Sparing ◽  
Gas Composition ◽  
Function Score ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Penile Rehabilitation

Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postoperative period during neuropraxia. The use of vacuum devices should be prescribed to patients with preserved veno-occlusive mechanism, which should be confirmed by dynamic duplex penile ultrasound.

Recovery of Erectile Function After Nerve Sparing Radical Prostatectomy and Penile Rehabilitation With Nightly Intraurethral Alprostadil Versus Sildenafil Citrate

2010 ◽  
Vol 183 (6) ◽  
pp. 2451-2456 ◽  
Author(s):  
Andrew R. McCullough ◽  
Wayne G. Hellstrom ◽  
Run Wang ◽  
Herbert Lepor ◽  
Kristofer R. Wagner ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Erectile Function ◽  
Sildenafil Citrate ◽  
Nerve Sparing ◽  
Penile Rehabilitation

Bone Formation Effect of HA/β-TCP Composite Powders in Rabbit Calvarial Bone Defects: Histologic Study

2007 ◽  
Vol 330-332 ◽  
pp. 1331-1334
Author(s):  
Hyun Seon Jang ◽  
Kwang Ho Lee ◽  
Moon Jin Jeong ◽  
Joo Cheol Park ◽  
Heung Joong Kim ◽  
...  
Keyword(s):  
Bone Formation ◽  
Venous Blood ◽  
Control Group ◽  
Composite Powders ◽  
Calvarial Bone ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Osseous Defects ◽  
Experimental Group

This study evaluated the histology results of surgically created bone cavities in the calvaria of rabbits that were subsequently filled with a HA/ß-TCP composite powder developed in Korea (Dentium, Korea). Ten young adult rabbits were used. Four defects were surgically produced in the calvaria of each rabbit. These defects were classified into 4 groups: the control group, no graft materials; experimental group I, normal saline + graft materials; experimental group II, venous blood + graft materials; and experimental group III, graft materials only. The defects were randomly filled with the graft materials. The rabbits were sacrificed with at 1-, 2-, 4-, 6- and 8- weeks after surgery. The histology specimens were prepared using the general method with H & E staining at a 6 ㎛ thickness. Histologically, the degree of new bone formation was similar in all experimental groups. However, for experimental group II, many cells had gathered around the graft materials 1-week after surgery, and new bone formed slightly faster and than in the other groups. No bone formation was observed in the control group. Based on histology findings, the new HA/ß- TCP composite powders appeared to act as a scaffolding material for the regeneration of osseous defects.

scholarly journals Is There a Rationale for Penile Rehabilitation Following Radical Prostatectomy?

2014 ◽  
Vol 9 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Yagil Barazani ◽  
Peter J. Stahl ◽  
Harris M. Nagler ◽  
Doron S. Stember
Keyword(s):  
Radical Prostatectomy ◽  
Erectile Function ◽  
Tissue Injury ◽  
Conclusive Evidence ◽  
Nerve Sparing ◽  
Erectile Tissue ◽  
Function Recovery ◽  
Actual Use ◽  
Penile Rehabilitation

Erectile function recovery after radical prostatectomy (RP) is an increasingly prominent quality-of-life outcome following surgery. Following RP many men, despite the advent of cavernous nerve-sparing surgical technique, have moderately or significantly impaired erectile function (EF). The term penile rehabilitation (PR) is used to define interventions that maintain the health of erectile tissue in the context of nervous, vascular, and structural tissue injury. The goal of PR is to regain, as closely re-approximate, preoperative erectile function. PR is based on an increasing volume of preclinical and clinical data, but conclusive evidence of efficacy has not been established, and therefore the concept of PR remains controversial. The optimal PR regimen has not been established, but all strategies rely on one or more erectile dysfunction treatments to be administered on a regular basis regardless of actual use for sexual activity. This review highlights recent studies and evidence related to PR.

Microsurgical anatomy of the tentorial sinuses

1989 ◽  
Vol 71 (6) ◽  
pp. 923-928 ◽  
Author(s):  
Toshio Matsushima ◽  
Satoshi O. Suzuki ◽  
Masashi Fukui ◽  
Albert L. Rhoton ◽  
Evandro de Oliveira ◽  
...  
Keyword(s):  
Venous Blood ◽  
Free Edge ◽  
Microsurgical Anatomy ◽  
Posterior Portion ◽  
Content Type ◽  
Group Iii ◽  
Group I ◽  
Bridging Veins ◽  
Group Ii ◽  
Tentorial Sinus

✓ Variations of the tentorial sinus of cadaver cerebellar tentoria were examined under a surgical microscope. The tentorial sinuses were classified into four groups: Group I, in which the sinus receives venous blood from the cerebral hemisphere; Group II, in which the sinus drains the cerebellum; Group III, in which the sinus originates in the tentorium itself; and Group IV, in which the sinus originates from a vein bridging to the tentorial free edge. The tentorial sinuses of Groups I and II were frequently located in the posterior portion of the tentorium. The sinuses of Group I were short and most frequently present in the lateral portion of the tentorium. The tentorial sinuses of Group II, which were usually large and drained into the dural sinuses near the torcular, were separated into five subtypes according to the draining veins and direction of termination. The tentorial sinuses of Groups III and IV were located near the tentorial free edge or the straight sinus. The draining patterns of the tentorial sinuses and their draining veins (so-called “bridging veins”) were present in most cases. Knowledge of this anatomy can benefit the neurosurgeon carrying out repair near or on the cerebellar tentorium.

scholarly journals Preclinical Evidence for the Benefits of Penile Rehabilitation Therapy following Nerve-Sparing Radical Prostatectomy

2008 ◽  
Vol 2008 ◽  
pp. 1-10 ◽  
Author(s):  
M. Albersen ◽  
S. Joniau ◽  
H. Claes ◽  
H. Van Poppel
Keyword(s):  
Erectile Dysfunction ◽  
Radical Prostatectomy ◽  
Erectile Function ◽  
Nerve Fibers ◽  
Nerve Sparing ◽  
Pde5 Inhibitors ◽  
Rehabilitation Therapy ◽  
Erectile Tissue ◽  
Vasoactive Substances ◽  
Penile Rehabilitation

Erectile dysfunction following radical prostatectomy remains a frequent problem despite the development of nerve-sparing techniques. This erectile dysfunction is believed to be neurogenic, enhanced by hypoxia-induced structural changes which result in additional veno-occlusive dysfunction. Recently, daily use of intracavernous vasoactive substances and oral use of PDE5-inhibitors have been clinically studied for treatment of postprostatectomy erectile dysfunction. Since these studies showed benefits of “penile rehabilitation therapy,” these effects have been studied in a preclinical setting. We reviewed experimental literature on erectile tissue preserving and neuroregenerative treatment strategies, and found that preservation of the erectile tissue by the use of intracavernous nitric oxide donors or vasoactive substances, oral PDE5-inhibitors, and hyperbaric oxygen therapy improved erectile function by antifibrotic effects and preservation of smooth muscle. Furthermore, neuroregenerative strategies using neuroimmunophilin ligands, neurotrophins, growth factors, and stem cell therapy show improved erectile function by preservation of NOS-containing nerve fibers.

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