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Radical Pelvic Surgery (radical + pelvic_surgery)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Laboratory Forum: Cavernous Nerve Injury Using Rodent Animal Models

THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2008
Onder Canguven
ABSTRACT Introduction., With the advance of the "nerve sparing" technique in radical pelvic surgeries, medically unaided rates of normal erectile function following surgery have improved. Precise determinations of post-surgery erection recovery, however, continue to be problematic and rates of normal erectile function range from 9% to 86%. It is understood that injury to cavernous nerves (CNs) occurs despite modern modifications of the surgery, although the precise pathophysiologic mechanisms of surgical erectile dysfunction are not completely understood. Aim., To describe the experimental models of CN injury in small rodents, including both survival surgery (CN injury) and non-survival surgery (monitoring of intracavernosal pressure and arterial blood pressure) models. We also summarize studies on experimental procedures relating to these CN injury models and critique techniques according to their advantages and disadvantages. Main Outcome Measure., Data from a peer review literature search on the topic of CN injury in rodent models. Methods., A comprehensive review of the literature was performed using PubMed. "Cavernous nerve injury" and "animal model" were used as search terms, and a manual bibliographic review of cross-referenced items was performed. Results., Assorted molecular, morphological, and physiological changes are measurable after CN injury in rodent models. Conclusion., Various models of CN injury have been applied successfully and offer insights regarding erectile function recovery effects. Canguven O, and Burnett A. Cavernous nerve injury using rodent animal models. J Sex Med 2008;5:1776,1785. [source]

Increased proximal urethral sensory threshold after radical pelvic surgery in women,,

NEUROUROLOGY AND URODYNAMICS, Issue 2 2007
Thomas M. Kessler
Abstract Aim To identify factors that potentially influence urethral sensitivity in women. Patients and Methods The current perception threshold was measured by double ring electrodes in the proximal and distal urethra in 120 women. Univariate analysis using Kaplan,Meier models and multivariate analysis applying Cox regressions were performed to identify factors influencing urethral sensitivity in women. Results In univariate and multivariate analysis, women who had undergone radical pelvic surgery (radical cystectomy n,=,12, radical rectal surgery n,=,4) showed a significantly (log rank test P,<,0.0001) increased proximal urethral sensory threshold compared to those without prior surgery (hazard ratio (HR) 4.17, 95% confidence interval (CI) 2.04,8.51), following vaginal hysterectomy (HR 4.95, 95% CI 2.07,11.85), abdominal hysterectomy (HR 5.96, 95% CI 2.68,13.23), or other non-pelvic surgery (HR 4.86, 95% CI 2.24,10.52). However, distal urethral sensitivity was unaffected by any form of prior surgery. Also other variables assessed, including age, concomitant diseases, urodynamic diagnoses, functional urethral length, and maximum urethral closure pressure at rest had no influence on urethral sensitivity in univariate as well as in multivariate analysis. Conclusions Increased proximal but unaffected distal urethral sensory threshold after radical pelvic surgery in women suggests that the afferent nerve fibers from the proximal urethra mainly pass through the pelvic plexus which is prone to damage during radical pelvic surgery, whereas the afferent innervation of the distal urethra is provided by the pudendal nerve. Better understanding the innervation of the proximal and distal urethra may help to improve surgical procedures, especially nerve sparing techniques. Neurourol. Urodynam. 26:208,212, 2007. © 2006 Wiley-Liss, Inc. [source]

Provision of radical pelvic urological surgery in England, and compliance with improving outcomes guidance

BJU INTERNATIONAL, Issue 10 2009
Erik K. Mayer
OBJECTIVE To investigate compliance with Improving Outcomes Guidance (IOG) for radical pelvic surgery in England, and explore the pattern of service provision for radical cystectomy (RC) and radical prostatectomy (RP) before and after the introduction of IOG. METHODS For the period 2000/01,2006/07, all admissions for RC and RP were extracted from Hospital Episode Statistics (HES). At the institutional level, the numbers of RC and RP cases were combined to assess adherence to IOG. The IOG catchment populations for each institution were calculated by linking HES data to census ward population data. The pattern of service provision for RC and RP was independently assessed by assigning institutions into low-, medium- and high-volume groups of roughly equal volumes a priori, based on the ascending order of annual RC or RP rate, respectively. For RC it was also possible to explore the between-institution referral activity for RC by identifying the ,final endoscopic bladder procedure' that occurred immediately before the RC for each patient. This gave an indication of where the diagnosis and decision for RC had been made. RESULTS The percentage of institutions achieving the recommended IOG minimal case volume of 50 per year increased significantly between 2000/01 and 2006/07 (36% in odds per year, P < 0.001; odds ratio 1.36, 95% confidence interval 1.24,1.50), although absolute numbers remained relatively low (34% in 2006/07). Only one institution had a catchment population greater than the recommended 1 million. The total number of institutions performing RC decreased significantly over the years (P = 0.03), whereas for RP the decrease was not significant (P = 0.6). The decrease reflected a decline in the number of low-volume institutions, both for RC and RP, although this decline was not more than expected by chance. There had been a significant increase in the percentage of patients referred to another provider for their RC, from 5.5% in 2000/01 to 19.6% in 2006/07 (28% rise in odds per year, P < 0.001: odds ratio 1.28, 95% confidence interval 1.23,1.33). CONCLUSION There was evidence of centralization of radical pelvic urological surgery, although it is only relatively recently that this seems to have taken place with any certainty. The absolute numbers of providers achieving the IOG minimum caseload standard was relatively low. What impact this has had, if any, on the quality of patient care is yet to be fully determined. [source]