Objective
Classic anatomical methods have limitations in micro determination of nerve fibre location. Furthermore, the precise detection of the nerve fibres nature is not possible by means of ...dissection. The combination of immunohistochemistry and three-dimensional reconstruction could be used to resolve these limitations of morphological sciences. Our aim is to describe the evolution of computer-assisted anatomic dissection (CAAD), which is an original method applied to study the distribution of intra-pelvic nerves in anatomic research.
Materials and methods
Serial transverse sectioning of the pelvic region in rabbit, human fetus, infant and adult cadaver was performed. Sections were immuno-histochemically stained and digitized with a high optical resolution scanner. Photoshop 7 software was used in regrouping of the adult cadaver sections then a tri-dimensional reconstruction was achieved using WinSurf software.
Results
The 3D reconstruction of the immuno-histochemically stained histologic sections of the pelvis allowed for precise structural identification of the prostate and its innervations (in fetus, infant and adult). In addition, we reconstructed the entire intra-pelvic organs with accurate demonstration of the location of both adrenergic and cholinergic pathways. Moreover, we performed a virtual dissection of each of the pelvic structures with description of the exact location of the inferior hypogastric plexus, as well as the nature and the distribution of its fibres.
Conclusion
The CAAD is an original method in anatomic research, which illustrates the fact that descriptive anatomy is still a dynamic science. This method allows for a 3D presentation of the intra-organic innervation, the nature of the nerve fibres, and the distribution of receptors and their neurotransmitters. This technique improves the understanding of the complex anatomic regions such as the pelvis from both surgical and educational point of view.
Introduction : Les séquelles érectiles de la prostatectomie totale pour cancer concernent la majorité des patients. Des protocoles de remplacement nerveux, prometteurs sur des modèles animaux, n’ont ...pas amélioré la récupération chez l’homme dont l’anatomie nerveuse pelvienne est plus complexe.Matériel et méthodes : Trois études expérimentales chez le rat ont évalué différentes stratégies, seules ou combinées, de réparation de nerfs caverneux lésés par écrasement : l’engainement synthétique ou autologue et l’adjonction locale ou systémique de traitements pharmacologiques. Deux études anatomiques ont consisté à mettre au point et à appliquer une technique de dissection assistée par ordinateur permettant une analyse morphologique et fonctionnelle de l’innervation péri-prostatique chez 7 fœtus masculins et 4 sujets cadavériques.Résultats : L’engainement synthétique du nerf caverneux lésé a permis une récupération érectile partielle. En y associant une délivrance locale de Triiodothyronine ou systémique de sildénafil, la récupération était complète. Un traitement par sildénafil seul permettait également une récupération complète. L’engainement autologue était inefficace. Les fibres nerveuses de la bandelette neuro-vasculaire se distribuaient en fibres antérieures destinées au sphincter urétral, antéro-latérales (nerfs caverneux) destinées aux corps caverneux et postéro-latérales (nerfs spongieux) destinées aux corps spongieux.Conclusion : Les nerfs destinés aux corps érectiles ont une position plus antérieure que celle décrite dans les traités chirurgicaux de référence. Ce trajet doit être pris en compte avant d’envisager des études cliniques de réparation nerveuse. Les stratégies de réparation du nerf caverneux devraient être adaptées au plan d’éxérèse envisagé et à la qualité de la préservation nerveuse réalisée.
Introduction : Erectile dysfunction occurs in more than half of the patients after a radical prostatectomy despite nerve-preserving surgical techniques. Nerve replacement protocols have been successful in animal models but they failed in improving the erectile function recovery in men where the pelvic nervous anatomy is more complex.Methods : Three experimental studies in rats have evaluated three different strategies, alone or in combination, to repair cavernous nerves after a crush-injury : guiding the nerve with an autologous or a synthetic disposal and adding local or systemic pharmacological treatments. Two anatomical studies have developped and applied a computer-assisted anatomical dissection technique to perform a morphological and a functional analysis of the peri-prostatic innervation in 7 male fetuses and 4 cadaveric subjects.Results : The erectile function recovery was partial after implantation of artificial conduits and complete with an additional local delivery of Triiodothyronine or systemic delivery of sildenafil. Sildenafil treatment alone also allowed full recovery. Autologous conduits were ineffective. The neurovascular bundles had distal divisions : anterior fibers innervated the urethral sphincter, antero-lateral fibers (cavernous nerves) innervated the corpora cavernosa and postero-lateral fibers (spongious nerves) innervated the corpora spongiosa.Conclusion : The position of the erectile fibers of the neurovascular bundles is more anterior than classically described. This pathway has to be considerated before any clinical study for cavernous nerve repair. For each patient, the planned type of nerve-preservation should determine the strategy for the nerve repair.
Despite advances in the diagnosis of prostate cancer over the past century, it remains a leading cause of cancer related death. A recent recommendation against screening has further complicated the ...diagnosis and management of this condition. It remains to be demonstrated if newer diagnostic modalities will have an impact on mortality rates. Most certainly, not all prostate cancers need to be diagnosed, and methods of accurately diagnosing those cancers that lead to death needs more work. In this review article, we describe the different techniques, approaches and diagnostic accuracies of the currently used biopsy methods.
A promoting effect of thyroid hormones has been established on the maturation of central and peripheral nervous systems. However, effects on autonomic nerves have never been experimentally ...investigated.
To assess the effect of a local treatment combining silicone guides and local administration of Triiodothyronine (T3) on the erectile function and the histological neuroregeneration of crushed cavernous nerves (CNs) in rats.
Forty-five rats were divided into five equal groups: SHAM surgery, guide without crush, crush, crush+guide, crush+guide+T3. All surgical procedures were bilateral. CNs were crushed with microvascular bulldog clamp of 100g/cm2. A silicone guide was placed around the nerves. The guides were filled with T3 neuroregenerative solution.
Erectile function was assessed 10 weeks post-operatively. Intra-cavernous pressure (ICP) and mean arterial pressure (MAP) were monitored during electrical stimulation of CNs at various frequencies. The main outcome was hardness of erection defined as ΔICP/MAP. Fluorescent immunohistochemical analysis of CNs was performed to assess regeneration of nerves morphologically.
Electrophysiological data showed increased recovery of erectile function in the group with guide+T3 neuroregenerative solution compared with the empty guide. Immunohistochemical analysis of cavernous nerves demonstrated in morphology that regenerated axons were straighter in nerves with guide and more regular if guides had been filled with T3.
The use of guides prevented axonal sprouting, facilitated functional neuroregeneration and enabled a local delivery of thyroid hormones. Triiodothyronine improved neuroregeneration and recovery of erectile function after a nerve-sparing–like injury in a rat model. Bessede T, Alsaid B, Ferretti L, Pierre M, Bernabé J, Giuliano F, Karam I, Benoît G, and Droupy S. Effect of a local delivery of triiodothyronine (T3) within neuroregenerative guide on recovery of erectile function in a rat-model of cavernous nerve injury.
Micro-Abstract Nephron-sparing surgery (NSS) is recommended for renal tumors < 7 cm and allows better overall survival with oncological results similar to radical nephrectomy. We retrospectively ...analyzed data from 168 patients treated using NSS for large tumors. In this selected population, patients with elective indication had favorable oncological and morbidity outcomes. NSS indications could be expanded beyond the 7 cm cutoff.
