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Novel Mapping Method for the Intraoperative Neurophysiologic Monitoring of Sexual Function During Prostate Surgery

Martín-Palomeque, Guillermo*; Cabañes-Martínez, Lidia*; de Blas Beorlegui, Gema*; Moreno Galera, M del Mar*; López, Jaime R.; Burgos, Francisco Javier; Regidor Bailly-Baillière, Ignacio*

Journal of Clinical Neurophysiology: November 2018 - Volume 35 - Issue 6 - p 463–467
doi: 10.1097/WNP.0000000000000506
Original Research

Purpose: The occurrence of urinary incontinence and erectile dysfunction after surgical treatment for prostate cancer is a significant and lingering problem. The aim of this study is to revise and improve older techniques of intraoperative cavernous nerve mapping already in use to improve accuracy and reliability.

Methods: We prospectively studied this technique in 12 patients suffering from prostate cancer. Inhalation or intravenous anesthetic regimen was used with nondepolarizing muscle relaxants. Stimulation protocol was 30 Hz, 0.2 ms, 10 to 20 mA intensity and a maximum duration of 30 seconds. Recording was performed with a system for measuring pressure changes using a stainless steel needle electrode inside the cavernous bodies. Stimulation was systematically performed at three distinct moments during the surgery at various points. An increase or decrease in pressure of 4 cm of H20 in the cavernous bodies was considered a positive result and negative response when no changes occurred after 30 seconds of continuous stimulation.

Results: Of patients, 91.6% had positive responses to initial stimulation. The anesthetic regimen did not appear to significantly influence the responses in our series.

Conclusions: In light of the results of this study, the stimulation of the cavernous nerves may be a viable technique in the right context, which includes good patient selection (young patients with a localized tumor and with preserved potency). The major limitation is that mapping techniques are useful to localize functional nerves, but not to monitor function in a continuous manner.

*Clinical Neurophysiology Department, Hospital Ramón y Cajal, Madrid, Spain;

Departments of Neurology & Neurological Sciences and Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; and

Urology Department, Hospital Ramón y Cajal, Madrid, Spain.

Address correspondence and reprint requests to Guillermo Martin-Palomeque, MD, Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo, km 9,1. CP 28034 Madrid, Spain; e-mail: gmpalomeque@salud.madrid.org.

The authors have no funding or conflicts of interest to disclose.

© 2018 by the American Clinical Neurophysiology Society