MP37-03 REAL-TIME NERVE MAPPING DURING RARP TO IDENTIFY NERVES INVOLVED IN THE ERECTILE RESPONSE

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics - Benign & Malignant Disease1 Apr 2014MP37-03 REAL-TIME NERVE MAPPING DURING RARP TO IDENTIFY NERVES INVOLVED IN THE ERECTILE RESPONSE Ronald Kuhn Ronald KuhnRonald Kuhn View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1240AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nerve sparing during robotic assisted radical prostatectomy (RARP) typically focuses on preserving the parasympathetic nerves (PN) located within the neurovascular bundle (NVB) that are responsible for the filling phase of the erectile response. Studies have shown however, that a somatic nerve (SN) not located in the NVB, innervates the ischiocavernosus (IC), bulbospongiosus (BS), and external urethral sphincter (EUS), and is responsible for preventing venous leak and achieving the full tumescence needed for penetration by mediating the muscular phase of the erectile response. Using the ProPep Nerve Monitoring System (an FDA approved device for Nerve Monitoring (NM) during RARP), the ability to identify the location of this SN during RARP was investigated. METHODS During each of 50 consecutive RARP, 2 ProPep electrodes were introduced into the abdominal cavity and placed into the EUS on either side of the prostate. A computer program then delivered of a low level stimulus through the daVinci Maryland bipolar. When the tissue in question was touched with the bipolar, the stimulus was sent through the tissue and returned to a computer via the electrodes. The computer analyzed the signal and if the tissue being touched included the SN innervating the BS & IC, a compound motor action potential (CMAP) was seen in tile-pro in the daVinci console and the surgeon documented the location. RESULTS Using the ProPep NM device this SN was accurately identified in 100% of the 50 cases. No complications resulted from the use of the NM and less than 5 minutes was added to the operative time. The SN’s presence unilaterally or bilaterally varied from case to case as did the location relative to the urethra with the right side located between 1 o’clock and 5 o’clock and the left side between 7 o’clock and 11 o’clock. CONCLUSIONS Achieving an erection capable of penetration requires an autonomic component through PN’s in the NVB, and a somatic component through SN’s outside the NVB. Using this NM device the SN involved in this process was accurately, safely, and efficiently identified in 100% of cases. Furthermore, the laterality and location of the nerve was highly variable. It has been reported that venous leak accounts for up to 25% of erectile dysfunction following RARP and it is the Author’s belief that further studies are warranted to explore the clinical benefits received as a result of the identification of this nerve during surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e392-e393 Advertisement Copyright & Permissions© 2014Metrics Author Information Ronald Kuhn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...