Baseline Erectile Function Alters the Cavernous Nerve Quantity and Distribution Around the Prostate
Baseline Erectile Function Alters the Cavernous Nerve Quantity and Distribution Around the Prostate
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DOI：
10.1016/j.juro.2010.06.108
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发表时间：
2010-11-01
影响因子：
6.6
通讯作者：
Tsukamoto, Taiji
中科院分区：
文献类型：
--
作者：
Hisasue, Shin-ichi;Hashimoto, Kohei;Tsukamoto, Taiji
目的：明确神经元型一氧化氮合酶阳性神经纤维在前列腺周围的分布及其影响因素。材料与方法：对23例(46侧)非神经保留根治性前列腺癌患者的术前国际勃起功能指数和最大阴茎周径变化资料进行研究。用神经元型一氧化氮合酶抗体进行免疫组织化学染色，将前列腺半球分为6个区，观察神经元型一氧化氮合酶阳性神经纤维在前列腺尖、中段和基底部的分布。以标本重量、患者年龄、体重指数、国际勃起功能指数和最大阴茎周长变化为变量，对神经元型一氧化氮合酶阳性神经纤维的数量进行多因素分析。阴茎周长最大变化小于或等于20 mm被认为是客观的勃起功能障碍。国际勃起功能指数-勃起功能领域评分中位数为12(0~24)，最大阴茎周径变化中位数为25.0 mm(2.70~38.3)。在神经元型一氧化氮合酶阳性神经纤维中，65%分布在3~5点的六分仪内(p<；0.001)。Logistic回归分析显示，最大阴茎周长变化是唯一有意义的变量(p=0.019)。客观勃起功能障碍组的纤维计数(中位数1,500，范围382至2,760)高于非勃起功能障碍组(中位数649，范围156至2,916)(p=0.009)。两组患者海绵体神经纤维计数在3~6点处差异有统计学意义，尤以顶端差异显著。结论：基础勃起功能对海绵体神经的数量和分布有较大影响。对于勃起功能障碍患者，保留神经血管束中的海绵体神经，尤其是顶端的海绵体神经仍然是必不可少的。
Purpose: We clarified the distribution of neuronal nitric oxide synthase positive nerve fibers around the prostate and factors contributing to fiber quantity.Materials and Methods: We investigated 46 hemispheres of 23 nonnerve sparing radical prostatectomy specimens from patients with available preoperative International Index of Erectile Function and maximum penile circumferential change data. We performed immunohistochemical staining with neuronal nitric oxide synthase antibody, and divided the prostatic hemisphere into 6 zones to assess the distribution of neuronal nitric oxide synthase positive nerve fibers at the apex, midportion and base of the prostate. Multivariate analysis of the quantity of overall neuronal nitric oxide synthase positive nerve fibers used the variables of specimen weight, patient age, body mass index, International Index of Erectile Function and maximum penile circumferential change. A maximum penile circumferential change of 20 mm or less was considered objective erectile dysfunction.\Results: Median patient age was 68 years (range 57 to 74). Median International Index of Erectile Function-erectile function domain score was 12 (range 0 to 24) and median maximum penile circumferential change was 25.0 mm (range 2.70 to 38.3). Of the neuronal nitric oxide synthase positive nerve fibers 65% were distributed in a 3 to 5 o'clock sextant (p < 0.001). Logistic regression analysis revealed that maximum penile circumferential change was the single significant variable (p = 0.019). The fiber count was greater in the objective erectile dysfunction group (median 1,500, range 382 to 2,760) than in the nonerectile dysfunction group (median 649, range 156 to 2,916) (p = 0.009). The fiber count was significantly different between the 2 groups in the 3 to 6 o'clock area, especially at the apex.Conclusions: Baseline erectile function greatly impacts cavernous nerve quantity and distribution. Cavernous nerve preservation in the neurovascular bundle, especially at the apex, is still essential for patients with erectile dysfunction.