Efficacy of first-generation Cavermap to verify location and function of cavernous nerves during radical prostatectomy: A multi-institutional evaluation by experienced surgeons
Efficacy of first-generation Cavermap to verify location and function of cavernous nerves during radical prostatectomy: A multi-institutional evaluation by experienced surgeons
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DOI：
10.1016/s0090-4295(00)01067-0
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发表时间：
2001-03-01
期刊：
影响因子：
2.1
通讯作者：
Steiner, MS
中科院分区：
文献类型：
--
作者：
Walsh, PC;Marschke, P;Steiner, MS
目标。目的：利用5位经验丰富的外科医生，评价第一代Cavermap手术辅助设备在术中识别海绵状神经和预测性功能恢复方面的效果。本研究的目的不是确定该装置是否能提高保护神经的能力或改善预后。50例年龄小于60岁的男性（平均年龄52.5岁，范围43 - 59岁）临床局限性前列腺癌（76% T1c，平均Gleason评分6分，前列腺特异性抗原水平低于10 ng/mL）行保留神经的根治性前列腺切除术（90%双侧）。术中，在视觉上识别神经血管束后，使用Cavermap装置检测海绵状神经的存在，并确定前列腺切除后神经是否完整。使用国际勃起功能指数评估勃起功能；如果男性至少有一半的尝试能够在无辅助的情况下完成性交，那么他们就被认为是有能力的。前列腺切除前，神经血管束刺激的肿胀反应率为87.8%；当不含神经维管束的组织受到刺激时，54%的人没有出现肿胀反应。前列腺切除术后，90%的患者双侧对刺激有反应，5%的患者单侧有反应，5%的患者无反应。术后12个月，71%的患者仍有效。在前列腺切除后出现双侧刺激的患者中，78%的患者在12个月时仍然有效。由经验丰富的外科医生进行根治性前列腺切除术后，患者报告的60岁以下男性的效力率很高。经经验丰富的外科医生鉴定，洞穴地图刺激在定位神经血管束方面显示出87.8%的敏感性和54%的特异性。第一代设备缺乏特异性，限制了其在决定哪些结构可以安全保留或切除方面的应用。由于几乎所有患者在切除前列腺后都表现出积极的反应，因此刺激对预测性功能恢复的价值尚未确定。中华泌尿外科杂志（英文版），2001。(C) 2001, Elsevier Science Inc.；
Objectives. To evaluate, using five experienced surgeons, the efficacy of the first-generation Cavermap Surgical Aid to identify the cavernous nerves intraoperatively and to predict the recovery of sexual function. This study was not designed to determine whether this device improves the ability to preserve the nerves or improve outcome.Methods. Fifty men younger than 60 years old (mean age 52.5 years; range 43 to 59) with clinically localized prostate cancer (76% T1c, mean Gleason score 6, prostate-specific antigen level less than 10 ng/mL) underwent nerve-sparing radical prostatectomy (90% bilateral). Intraoperatively, the Cavermap device was used to test for the presence of the cavernous nerves once the neurovascular bundle was identified visually and to determine whether the nerves were intact after the prostate was removed. Erectile function was evaluated using the International Index of Erectile Function; men were considered potent if they were able to achieve unassisted intercourse in at least one half of their attempts.Results. Before the removal of the prostate, the tumescence response to stimulation of the neurovascular bundle was 87.8%; when tissue not containing the neurovascular bundle was stimulated, no tumescence response occurred in 54%. After prostatectomy, a bilateral response to stimulation occurred in 90%, a unilateral response in 5%, and no response in 5%. Postoperatively, 71% of the patients were potent at 12 months. In the patients who demonstrated bilateral stimulation after removal of the prostate, 78% were potent at 12 months.Conclusions. After radical prostatectomy performed by experienced surgeons, patient-reported potency rates in men younger than 60 years of age were high. Cavermap stimulation demonstrated an 87.8% sensitivity and 54% specificity in locating the neurovascular bundle as identified by experienced surgeons. The lack of specificity of this first-generation device limits its application for deciding which structures can be safely preserved or excised. Because virtually ail patients demonstrated a positive response after removal of the prostate, the value of stimulation to predict the recovery of sexual function is yet to be determined. UROLOGY 57: 491-494, 2001. (C) 2001, Elsevier Science Inc.