The value of preoperative magnetic resonance imaging in detecting the distribution of neurovascular bundles before the nerve-sparing laproscopic radical prostatectomy
10.3760/cma.j.issn.1000-6702.2018.07.010
- VernacularTitle:术前磁共振检查神经血管束分布差异在保留神经的腹腔镜根治性前列腺切除术中的应用价值
- Author:
Shiping WEI
1
;
Fan CHENG
;
Haoyong LI
;
Weimin YU
;
Ting RAO
Author Information
1. 武汉大学人民医院泌尿外科
- Keywords:
Neurovascular bundle;
Distribution;
Ventral;
Magnetic resonance imaging;
Erectile function;
Nerve-sparing laparoscopic radical prostatectomy
- From:
Chinese Journal of Urology
2018;39(7):522-526
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the preoperative magnetic resonance imaging (MRI)examination of the distribution of neurovascular bundles (NVB) around the prostatic capsule,and its clinical value in the nerve-sparing laparoscopic radical prostatectomy (NS-LRP).Methods The clinical data of 42 patients with clinically localized prostate cancer who were admitted from January 2008 to January 2017 were retrospectively analyzed.Age ranged from 58 to 74 years,with an average of 68 years.Preoperative serum PSA range from 0.94 to 12.28 ng/dl,with an average of 7.01 ng/dl.Preoperative Gleason score range from 6 to 8,with an average of 6.Clinical stage:T1-T2 37 cases,T3 5 cases.The average preoperative International Erectile Function Index questionnaire-5 (IIEF-5) 21,of which 23 cases had normal erectile function (IIEF-5 ＞ 22).All the 42 patients underwent MRI examination before operation.According to the distribution of NVB around the prostatic capsule,they were divided into 3 groups:17 cases in group A,and no NVB was evident in all cases.In group B,8 cases were visible but not obvious.In group C,17 cases were evident NVB.There was no significant difference in age,preoperative serum PSA and Gleason score between the three groups (P ＞ 0.05).The preoperative IIEF-5 in group A,B,and C were 19.5,22.8,and 21.5,respectively,with no statistically significant difference (P ＞ 0.05).All 42 cases received NS-LRP under general anesthesia.The differences in IIEF-5 before and after surgery were compared between the three groups.Results In this study,42 cases were successfully completed.42 patients were followed up for 12 to 36 months,with an average of 14.1 months.In group A,B,and C,postoperative IIEF-5 was 8.0,14.1,and 15.5,respectively,which was statistically significant compared with preoperative values (P ＜ 0.05).The decrease of IIEF-5 afteroperation in group A was significantly different from that of group Band C (P ＜0.05).Conclusions Compared with patients with visible NVB on MRI examination,patients have no visible NVB observed on MRI with erectile function-related nerves around the prostatic capsule may be walking on both sides of the prostatic capsule and spreading over the entire anterior ventral surface of the prostate.To maxium-preserve NVB and postoperative erectile function to the utmost,NS-LRP surgery should be more accurately dissected on both sides and ventral side of the prostatic capsule.
