EARLY EXPERIENCE WITH INTRAOPERATIVE CAVERNOUS NERVE-STIMULATION WITHPENILE TUMESCENCE MONITORING TO IMPROVE NERVE SPARING DURING RADICAL PROSTATECTOMY

Objectives. To determine if intraoperative stimulation of the cavernou s nerves while monitoring changes in penile tumescence to map the cour se of these nerves would result in an improvement in nerve sparing and erectile function after radical prostatectomy. Methods. Patients were eligible for this pilot study if they were undergoing a radical prost atectomy and were candidates for a nerve-sparing approach. Erectile fu nction was assessed by patient self-reporting and questionnaire before surgery and by patient self-reporting periodically 12 months after su rgery. A cavernous nerve stimulator and tumescence-monitoring device w as used during radical 'prostatectomy to identify the course of the ca vernous nerves and guide the surgeon in avoiding nerve damage. Patient s were monitored for any evidence of complications and/or adverse even ts for 1 year from time of surgery. Results. Twenty-six patients were recruited to the trial. Nerve stimulation and tumescence monitoring wa s performed in 23 patients. Twenty-one of 23 patients demonstrated a t umescence response to intraoperative nerve stimulation. Nineteen of 21 patients reported erectile function preoperatively. Seventeen (89%) o f 19 patients demonstrated a tumescence response during surgery. Sixte en (94%) of the 17 patients who demonstrated a response to nerve stimu lation and for whom the surgery was guided by the tumescence response reported the ability to have erections after surgery. No side effects due to the use of the device were reported. Only 3 (12%) of 25 patient s had positive margins confined to the lateral margin and/or apex whos e modifications associated with nerve sparing could conceivably have a ltered margin status. Conclusions. These clinical data suggest that an intraoperative tumescence response to cavernous nerve stimulation may guide the surgeon in preserving cavernous nerves and improving erecti le function after radical prostatectomy. UROLOGY 52: 537-542, 1998. (C ) 1998, Elsevier Science Inc. All rights reserved.