Nerve-sparing surgery

Last updated

Nerve-sparing surgery is a type of surgery that attempts to save the nerves near the tissues being removed. [1]

It is commonly applied in radical retropubic prostatectomy, a surgical treatment for prostate cancer, in which damage to nerves during surgery can lead to complications including urinary incontinence and impotence. In nerve-sparing radical prostatectomy, initially developed by Dr. Patrick Walsh in the 1980s, [2] surgeons identify and attempt to avoid damaging the nerves. Surgeons may visually identify the cavernous nerves of penis or apply an electrical stimulation penile plethysmograph diagnostic test to verify the nerves, and so avoid damaging them. The bilateral approach attempts to spare the nerves on both sides of the prostate. The unilateral approach is specific to one side, usually because the prostate cancer has spread to prevent a bilateral nerve sparing approach; studies suggest that this approach leads to better results than non-nerve-sparing surgery, but that patient age and previous erectile function have a significant influence on post-operative results. [3]

Related Research Articles

Erectile dysfunction Human disease which results in trouble maintaining an erection

Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men. Through its connection to self-image and to problems in sexual relationships, erectile dysfunction can cause psychological harm.

Prostate Gland of the male reproductive system in most mammals

The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes, and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular tissue as well as connective tissue.

Prostate cancer Male reproductive organ cancer

Prostate cancer is cancer of the prostate. The prostate is a gland in the male reproductive system that surrounds the urethra just below the bladder. Most prostate cancers are slow growing. Cancerous cells may spread to other areas of the body, particularly the bones and lymph nodes. It may initially cause no symptoms. In later stages, symptoms include pain or difficulty urinating, blood in the urine, or pain in the pelvis or back. Benign prostatic hyperplasia may produce similar symptoms. Other late symptoms include fatigue, due to low levels of red blood cells.

Pancoast tumor Medical condition

A Pancoast tumor is a tumor of the apex of the lung. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae. Most Pancoast tumors are non-small-cell lung cancers.

Prostatectomy Surgical removal of all or part of the prostate gland

Prostatectomy as a medical term refers to the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.

Radical retropubic prostatectomy

Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. It is most often used to treat individuals who have early prostate cancer. Radical retropubic prostatectomy can be performed under general, spinal, or epidural anesthesia and requires blood transfusion less than one-fifth of the time. Radical retropubic prostatectomy is associated with complications such as urinary incontinence and impotence, but these outcomes are related to a combination of individual patient anatomy, surgical technique, and the experience and skill of the surgeon.

Radical perineal prostatectomy

Radical perineal prostatectomy is a surgical procedure wherein the entire prostate gland is removed through an incision in the area between the anus and the scrotum (perineum).

The cavernous nerves are post-ganglionic parasympathetic nerves that facilitate penile erection and clitoral erection. They arise from cell bodies in the inferior hypogastric plexus where they receive the pre-ganglionic pelvic splanchnic nerves (S2-S4).

A neurovascular bundle is a structure that binds nerves and veins with connective tissue so that they travel in tandem through the body.

Biochemical recurrence is a rise in the blood level of prostate-specific antigen (PSA) in prostate cancer patients after treatment with surgery or radiation. Biochemical recurrence may occur in patients who do not have symptoms. It may mean that the cancer has come back. Also called PSA failure and biochemical relapse.

Laparoscopic radical prostatectomy

Laparoscopic radical prostatectomy (LRP) is a form of radical prostatectomy, an operation for prostate cancer. Contrasted with the original open form of the surgery, it does not make a large incision but instead uses fiber optics and miniaturization.

Prostate brachytherapy

Brachytherapy is a type of radiotherapy, or radiation treatment, offered to certain cancer patients. There are two types of brachytherapy – high dose-rate (HDR) and low dose-rate (LDR). LDR brachytherapy is the one most commonly used to treat prostate cancer. It may be referred to as 'seed implantation' or it may be called 'pinhole surgery'.

Ashutosh Tewari

Ashutosh K. Tewari is the chairman of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. He is a board certified American urologist, oncologist, and principal investigator. Before moving to the Icahn School of Medicine in 2013, he was the founding director of both the Center for Prostate Cancer at Weill Cornell Medical College and the LeFrak Center for Robotic Surgery at NewYork–Presbyterian Hospital. Dr. Tewari was the Ronald P. Lynch endowed Chair of Urologic Oncology and the hospital's Director of Robotic Prostatectomy, treating patients with prostate, urinary bladder and other urological cancers. He is a world leading urological surgeon, and has performed over 9,000 robotically assisted procedures using the da Vinci Surgical System. Academically, he is recognized as a world-renowned expert on urologic oncology with over 250 peer reviewed published papers to his credit; he is on such lists as America's Top Doctors, New York Magazine's Best Doctors, and Who's Who in the World. In 2012, he was given the American Urological Association Gold Cystoscope Award for "outstanding contributions to the field of urologic oncology, most notably the treatment of prostate cancer and the development of novel techniques to improve the outcomes of robotic prostatectomy."

Treatment for prostate cancer may involve active surveillance, surgery, radiation therapy – including brachytherapy and external-beam radiation therapy, proton therapy, high-intensity focused ultrasound (HIFU), cryosurgery, hormonal therapy, chemotherapy, or some combination. Treatments also extend to survivorship based interventions. These interventions are focused on five domains including: physical symptoms, psychological symptoms, surveillance, health promotion and care coordination. However, a published review has found only high levels of evidence for interventions that target physical and psychological symptom management and health promotion, with no reviews of interventions for either care coordination or surveillance. The favored treatment option depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors include the man's age, his general health, and his feelings about potential treatments and their possible side-effects. Because all treatments can have significant side-effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.

Orchiectomy Surgical removal of one or both testicles

Orchiectomy is a surgical procedure in which one or both testicles are removed, as a form of castration. The surgery is typically performed as treatment for testicular cancer, as a gender-affirming procedure for trans women, as management of advanced prostate cancer, and as a consequence of testicular torsion. Less frequently, orchiectomy may be performed due to atrophy of the testis or testes or following a trauma.

Roger Kirby

Roger Sinclair Kirby FRCS(Urol), FEBU is a British retired prostate surgeon and professor of urology, researcher, writer on men's health and prostate disease, founding editor of the journal Prostate Cancer and Prostatic Diseases and Trends in Urology and Men's Health and a fundraiser for prostate disease charities, best known for his use of the da Vinci surgical robot for laparoscopic prostatectomy in the treatment of prostate cancer. He is a co-founder and president of the charity The Urology Foundation (TUF), vice-president of the charity Prostate Cancer UK, trustee of the King Edward VII's Hospital and as of 2020 is president of the Royal Society of Medicine (RSM), London.

Michael Stifelman

Michael D. Stifelman, M.D.,, an internationally recognized American physician and urologist, is known for his work in upper tract urinary reconstructive surgery and use of multi- and single-port robotic surgical technology to perform complex cancer and non-cancer urological procedures. An innovator in the field of urological surgery, Dr. Stifelman leads a renowned Center of Excellence for robotic surgery at Hackensack University Medical Center in Hackensack, New Jersey, and serves as chair of the hospital’s Department of Urology.

Parotidectomy

A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The majority of parotid gland tumors are benign, however 20% of parotid tumors are found to be malignant. Parotidectomy is performed mostly by oral and maxillofacial surgeon and ENT surgeon.

Surgery for benign prostatic hyperplasia

If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia.

Anthony James Costello, FRACS, FRCSI, is an Australian urologist. He served as head of the department of urology at the Royal Melbourne Hospital, Australia. He established the first robotic prostate cancer surgery programme in Australia and published the first series of men who had laser surgery for benign prostate enlargements.

References

  1. "NCI Dictionary of Cancer Terms". National Cancer Institute. 2011-02-02. Retrieved 2020-05-05.
  2. Publishing, Harvard Health (9 March 2014). "Prostate cancer surgery: Is nerve-sparing safe?". Harvard Health. Retrieved 2020-05-05.
  3. Krishnan, R.; Katz, D.; Nelson, C. J.; Mulhall, J. P. (2014). "Erectile function recovery in patients after non-nerve sparing radical prostatectomy". Andrology. 2 (6): 951–954. doi: 10.1111/andr.282 . ISSN   2047-2927. PMID   25270277.


PD-icon.svg This article incorporates  public domain material from the U.S. National Cancer Institute document: "Dictionary of Cancer Terms".