Introduction. Erectile dysfunction (ED) remains a frequent complication after radical prostatectomy (RP). Accurate intraoperative identification and preservation of the neurovascular bundle (NVB) are crucial for postoperative erectile function. The aim of this study was to develop and evaluate a selective intraoperative NVB stimulation method for realtime assessment of erectile function during robot-assisted radical prostatectomy (RARP).
Materials and Methods. A total of seven patients with prostate cancer undergoing RARP were enrolled. Selective stimulation of the NVBs was performed before, during, and after surgery using two types of electrical stimuli (rectangular and quasitrapezoidal pulses) and two customized stimulating probes. The primary aim was to evaluate which stimulus-probe combination elicited a more effective NVB response. A novel monitoring system was developed to assess erectile function, including measurements of penile axial rigidity (ARIG), corpus cavernosum electromyographic activity (CC-EMG), intracavernosal blood pressure (ICBP), glans temperature (Tgp), glans galvanic skin response (GSR), toe photoplethysmogram (TPG), and ambient temperature (Ta).
Results. All stimulations were successfully performed. Distinct CC-EMG responses were observed in five patients, while ICP and TPIC increases were recorded in four. CC-EMG proved to be the most reliable and consistent indicator of NVB activation, allowing differentiation between right and left-side responses. Two patients showed no measurable physiological response.
Conclusion. Selective NVB stimulation during RARP is a feasible and safe method for intraoperative functional assessment of the cavernous nerves. The combination of stimulation and CC-EMG monitoring may provide valuable real-time information on nerve integrity, potentially improving postoperative erectile outcomes.
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