Abstract Background Detailed knowledge of nerve distribution in the neurovascular bundle (NVB) is essential to preserve sexual function after prostatic surgery. Objective To identify the location as ...well as the type (adrenergic, cholinergic, and sensory) of nerve fibres within the NVB and to provide a three-dimensional (3D) representation of their structural relationship in the human male foetus. Design, setting, and participants Serial transverse sections were performed every 150–200 μm in the pelvic portion of six human male foetuses (15–20 wk of gestation). Sections were treated with histologic and immunohistochemical methods (hematin-eosin-safran, Luxol Fast Blue, immunolabelling of protein S100, vesicular acetylcholine transporter, tyrosine hydroxylase, calcitonin gene-related peptide, and substance P). The 3D pelvic reconstruction was obtained from digitised serial sections using WinSurf software. Measurements NVB nerve location and type were evaluated qualitatively. Results and limitations The 3D reconstruction allowed precise identification of pelvic organ innervation. Nerve fibres derived from the inferior hypogastric plexus followed two courses: posterior and lateral, providing cholinergic, adrenergic, and sensory innervation to seminal vesicles, vas deferens, prostate, and urethral sphincter. Cavernous nerve fibres did not strictly follow the NVB course; they were distributed at several levels, in a fanlike formation. The main limitations of this study were the limited number of specimens available due to legal restriction and the time-consuming nature of the manually performed stages in the method. Conclusions The distribution of nerve fibres within the posterolateral prostatic NVB and the existence of mixed innervation in the posterior and lateral fibre courses at the level of the prostate and seminal vesicles give us an insight into how to minimise effects on sexual function during prostatic surgery. The 3D computer-assisted anatomic dissection represents an original method of applying anatomic knowledge to surgical technique to improve nerve preservation and decrease postoperative sexual complications.
Evolution in the concept of erection anatomy Awad, Ayman; Alsaid, Bayan; Bessede, Thomas ...
Surgical and radiologic anatomy (English ed.),
05/2011, Letnik:
33, Številka:
4
Journal Article
Recenzirano
Purpose
To review and to summarize the literature on anatomy and physiology of erection in the past three decades, especially the work done in our institution.
Methods
A search of the PubMed database ...was performed using keywords
erection, anatomy and erectile dysfunction
(
ED
). Relevant articles were reviewed, analyzed and summarized.
Results
Penile vascularisation and innervation vary substantially. Internal pudendal artery is the major source of penile blood supply, but a supralevator accessory pudendal artery that may originate from inferior vesical or obturator or external iliac arteries is not uncommon. Section of this artery during radical prostatectomy (RP) may adversely affect postoperative potency. Anastomoses between the supra and the infralevator arterial pathways are frequent. The cavernous nerves (CNs) contain parasympathetic and sympathetic nerve fibers and these nerves lie within leaves of the lateral endopelvic fascia. Anastomoses between the CNs and the dorsal nerve of the penis are common. Nitric oxide released from noradrenergic, noncholinergic neurotransmission of the CN and from the endothelium is the principal neurotransmitter-mediating penile erection. Interactions between pro-erectile and anti-erectile neurotransmitters are not completely defined. Finally, medial preoptic area and paraventricular nucleus are the key structures in the central control of sexual function and penile erection.
Conclusions
The surgical and functional anatomy of erection is complex. Precise knowledge of penile vascularisation and innervation facilitates treatment of ED especially after RP.
Summary
Antiviral therapy with interferon‐alpha (IFN‐alpha) and pegylated IFN‐alpha (PEG‐IFN‐alpha) for chronic hepatitis C (HCV)‐infected kidney recipients remains controversial. IFN‐alpha is not ...recommended in most cases because it induces severe acute graft rejection. However, IFN‐alpha, as PEG‐IFN‐alpha, is associated with a more pronounced immune response, and is well tolerated in HCV‐infected liver recipients without causing graft rejection. In combined liver–kidney transplant (LKT) recipients, IFN‐alpha has been occasionally used and appears to be well tolerated. All LKT recipients with a functioning kidney and liver having a HCV replication and who needed IFN‐alpha therapy have been included in the study. The occurrence of liver and/or renal acute rejection as well as the HCV replication has been collected. A total of 12 LKT patients treated with PEG‐IFN‐alpha plus ribavirin have been studied. No acute rejection was observed. Renal function remained stable during and after discontinuing treatment, without any graft dysfunction. Two patients had a partial viral response and four had a sustained viral response. All patients, whatever their viral response, had decreased liver‐enzyme levels. Response to PEG‐IFN‐alpha therapy was correlated with steroid dose and transaminase level when PEG‐IFN‐alpha was started. These data suggest that the combination therapy of PEG‐IFN‐alpha plus ribavirin did not have a higher risk of acute kidney‐graft rejection after liver–kidney transplantation.
Objective
to identify the location and the nature of communications between supra and infralevator pathways.
Materials and Methods
6 male and 6 female human fetal pelvic specimens, 15 to 32 wk of ...gestation, were studied using the 3D computer‐assisted anatomic dissection (CAAD) with neural, nitrergic and myelin sheath markers.
Results
Supra and infra levator neural pathways cross each other distally in spatial X shape area. They yield dual innervation in 5 directions: 1‐anal sphincter, 2‐levator ani muscle, 3‐urethral sphincter, 4‐corpus spongiosum and perineal muscles, and 5‐corpora cavernosa. The communications between the two pathways exist in 3 levels: proximal supralevator, intermediary intralevator and distal infralevator. Distal communications exist when autonomic nitrergic cavernous nerves interact with some somatic nitrergic branches of the dorsal penis/clitoris nerve and carried the nitrergic activity in its distal portion.
Conclusions
The pelvic structures responsible for sphincters continence and sexual function receive a dual innervation from the autonomic supralevator and the somatic infralevator pathways. Distal communication takes over the nitrergic activity to the distal part of cavernous bodies in both gender and represents an important structure which may impact erectile function, especially during reconstructive surgery.
Grant Funding Source: non
Purpose
To evaluate renal function and to identify factors associated with renal dysfunction in the elective indications setting of nephron-sparing surgery (NSS).
Methods
We retrospectively reviewed ...operative data and glomerular filtration rate (GFR) of 519 patients treated by NSS in an elective indications setting between 1984 and 2006 in eight academic institutions. A GFR decrease under the thresholds of 60 or 45 ml/min at last follow-up was considered a significant renal dysfunction. Univariate and multivariate regression models were used to assess multiple factors of renal function.
Results
Median age, tumor size, preoperative, and final GFR were 59.5 years (27–84), 2.7 cm (0.9–11), 79 (45–137), and 69 ml/min (
p
< 0.0001), respectively, with a median follow-up of 23 months (1–416). Hilar clamping was performed in 375 procedures (72.3 %). Significant GFR decrease was observed in 89 patients (17.1 %). Median operating time, hilar clamping duration, and blood loss were 137 min (55–350), 22 min (0–90), and 150 ml (0–4150), respectively. At univariate analysis, age (
p
= 0.002), preoperative GFR (
p
= 0.001), pedicular clamping (
p
= 0.01), and ischemia time (
p
= 0.0001) were associated with renal dysfunction. Age (
p
= 0.004; HR 1.2), pedicular clamping (
p
= 0.04; HR 1.3), and ischemia time (
p
= 0.0001; HR 1.8) remained independent risk factors for renal function deterioration in multivariate analysis.
Conclusion
Non- or time-limited clamping techniques are associated with preservation of renal function in the elective indications setting of NSS.
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