Prostatic Plexus Research Articles

Прямая перкутанная рентгенэндоваскулярная окклюзия вен простатического сплетения

In this work, we developed and introduced into clinical practice direct percutaneous X-ray endovascular occlusion of the veins of the prostatic plexus. Indications for this operation were a decrease in the quality of life associated with erectile dysfunction, the presence of proximal pathological venous drainage from the corpora cavernosa of the penis, lack of sufficient effect from taking of inhibitors phosphodiesterase type 5, refusal to use intracavernosal injections, refusal to undergo penile prosthetics, absence or low quality of visualization of the deep dorsal vein of the penis when using antegrade approaches to the prostatic plexus (transdorsal) as well as the complex anatomy of the pelvic veins when using retrograde approaches to the prostatic plexus (transfemoral and transcubital). The advantage of this technique was safety, extremely low morbidity and minimal hospitalization time. Keywords: venogenic erectile dysfunction, x-ray endovascular occlusion of the veins of the prostatic plexus

Vascular emergencies-The new COVID-19 crisis?

Vascular emergencies-The new COVID-19 crisis?

Diagnostic significance of phlebotonometry for evaluation of indications for angioplasty and stenting of compressed iliac veins in patients with varicocele and pelvic congestion disease

The aim of the studywas to assess the information content of the phlebotonometry method when determining indications for endovascular x-ray angioplasty and stenting of the iliac veins during their arterial compression.Materials and methods.Thirty-six patients with bilateral varicocele and varicose veins of the pelvic organs were examined. The examination included assessment of the condition using the international index of erectile function, ultrasound examination of the scrotum organs with color Doppler mapping, transrectal ultrasound of the prostate and veins of the prostatic plexus, magnetic resonance imaging of the inferior vena cava and pelvic vessels, venography of the renal caval and ileocaval segments, phlebotonometry of these segments in a calm state and during the Valsalva test.Results.Pressure gradient between left and right external iliac veins >2 mm Hg in a calm state was detected in 4 (11.1 %) patients, >3 mm Hg with Valsalva test – in 9 (25.0 %) patients, between the left and right common iliac veins >2 mm Hg in a calm state – in 3 (8.3 %) patients, >3 mm Hg with a Valsalva test, in 15 (41.7 %) patients. At the same time, in 20 (55.6 %) of 36 cases, phlebotonometry data were of a contradictory logic nature, which we attribute to the insufficient sensitivity of this research method. Our data suggest that collateral circulation leads not only to varicose veins of the pelvic organs, but also to equalization of pressure in the ipsilateral segments of the iliac veins due to the law of communicating vessels.Conclusion.Phlebotonometry in the diagnosis of iliac venous compression can only be used as an additional research method. Indications for angioplasty and stenting of the iliac veins during compression should be determined on the basis of clinical data, the severity of varicose veins of the pelvic organs according to the results of transrectal ultrasound examination, the results of magnetic resonance imaging of the inferior vena cava and pelvic vessels (or computed tomography of the abdominal organs with contrast or multispiral computed tomography of the abdominal cavity organs), radiopaque phlebography and intravascular ultrasound.The author declares no conflict of interest.All patients gave written informed consent to participate in the study.

Prostatic irradiation-induced sexual dysfunction: a review and multidisciplinary guide to management in the radical radiotherapy era (Part I defining the organ at risk for sexual toxicities).

Prostate cancer is the most common malignancy and the second leading cause of cancer-related death in men. Radiotherapy is a curative option that is administered via external beam radiation, brachytherapy, or in combination. Erectile, ejaculatory and orgasm dysfunction(s) is/are known potential and common toxicities associated with prostate radiotherapy. Our multidisciplinary team of physicians and/or scientists have written a three (3) part comprehensive review of the pathogenesis and management radiation-induced sexual dysfunction. Part I reviews pertinent anatomy associated with normal sexual function and then considers the pathogenesis of prostate radiation-induced sexual toxicities. Next, our team considers the associated radiobiological (including the effects of time, dose and fractionation) and physical (treatment planning and defining a novel Organ at Risk (OAR)) components that should be minded in the context of safe radiation treatment planning. The authors identify an OAR (i.e., the prostatic plexus) and provide suggestions on how to minimize injury to said OAR during the radiation treatment planning process.

Vascular conflicts in andrology. Part 2. Lower level arteryovenous conflicts

This paper presents a review of the literature on the prevalence, classification, symptoms, diagnosis and treatment of lower level arteriovenous conflicts. New approaches in the treatment of both arteriovenous conflicts and comorbid diseases such as varicocele, varicose veins of the pelvic organs, venogenic erectile dysfunction, chronic pelvic pain syndrome are presented. The data of the literature review can form the basis for the revision of approaches to the management of patients with varicocele, erectile dysfunction and chronic recurrent prostatitis. It is shown that x-ray surgical embolization of prostatic plexus veins alone or in combination with testicular vein embolization, angioplasty and iliac vein stenting is possible only at the junction of urology, andrology and x-ray surgery.

Эмболизация простатического венозного сплетения в лечении веногенной эректильной дисфункции

Эмболизация простатического венозного сплетения в лечении веногенной эректильной дисфункции

Interpositional Nerve Grafting of the Prostatic Plexus after Radical Prostatectomy.

Background:Injury to the prostatic plexus may occur during radical prostatectomy even with the use of minimally invasive techniques. Reconstruction of these nerves by interpositional nerve grafting can be performed to reduce morbidity. Although the feasibility of nerve reconstruction has been shown, long-term functional outcomes are mixed, and the role of nerve grafting in these patients remains unclear.Methods:A retrospective study was performed on 38 consecutive patients who underwent immediate unilateral or bilateral nerve reconstruction after open prostatectomy. Additionally, 53 control patients who underwent unilateral, bilateral, or non–nerve-sparing open prostatectomy without nerve grafting were reviewed. Outcomes included rates of urinary continence, erections sufficient for sexual intercourse, and ability to have spontaneous erections. Analysis was performed by stratifying patients by D’Amico score and laterality of nerve involvement.Results:Unilateral nerve grafting conferred no significant benefit compared with unilateral nerve-sparing prostatectomy. Bilateral nerve-sparing patients demonstrated superior functional outcomes compared with bilateral non–nerve-sparing patients, whereas bilateral nerve-grafting patients displayed a trend toward functional improvement. With increasing D’Amico score, there was a trend toward worsening urinary continence and erectile function regardless of nerve-grafting status.Conclusions:In the era of robotic prostatectomy, interpositional nerve reconstruction is not a routine practice. However, the substantial morbidity experienced in patients with bilateral nerve resections remains unacceptable, and therefore, nerve grafting may still improve functional outcomes in these patients. Further investigation is needed to improve the potential of bilateral nerve grafting after non–nerve-sparing prostatectomy.

A Comparative Study among Three Techniques of General Anesthesia for Ultrasound-Guided Transrectal Prostate Biopsy

Ultrasound-guided transrectal prostate biopsy is a reference in the diagnosis of prostate neoplasias. The higher the number of samples, the greater is the pain and discomfort. The objective of this study was to compare three anesthetic techniques in this group of patients. Forty-five patients were included in this study. Patients were divided into three groups: 1 - Propofol; 2 - Propofol + Prostatic Plexus Block; 3 - Propofol + Fentanyl. Patients were monitored with non-invasive blood pressure, continuous electrocardioscopy, pulse oximetry (SpO₂), and Bispectral Index. Patients did not receive pre-anesthetic medication. Intraoperative and postoperative hemodynamic parameters, intraoperative bispectral index, and postoperative visual analogue scale (VAS) and the use of dypirone to treat postoperative pain were evaluated. A significant difference among the three groups was not observed for: anthropometric parameters, amount of propofol, number of fragments, and duration of the exam. Hemodynamic parameters and SpO₂ presented similar behavior in all three groups. In group 1, the pain evaluated by the VAS was more severe and required more dypirone than in the other groups. Sedation with propofol alone for biopsy is associated with greater postoperative pain and discomfort than in prostatic plexus block or systemic fentanyl. Besides hypnosis, intraoperative analgesia is required to guarantee postoperative comfort.

Clinical efficacy of the microwave therapy for infectious and inflammatorydiseases of the urogenital system

The article describes complex treatment of 56 patients suffering from with chronic prostatitis and vesiculitis with the use of microwave irradiation (of the cm range). This complex therapy made it possible to achieve better results in the main group of patients vs. the comparison group (71 people), who received only drug treatment. Treatment resulted in the normalization of the leukocyte count in the prostate gland discharge and venous circulation rate in the prostatic plexus. A reduction in the diameter of the venous lumen was observed in more cases in the group of patients undergoing a microwave therapy than in the comparison group.

Lower urinary tract symptoms and its potential relation with late-onset hypogonadism

The study of the health status of the aging male takes presently a more integrative approach and it appears that ailments typical of male aging, such as lower urinary tract symptoms (LUTS), (visceral) obesity, metabolic syndrome and erectile failure are significantly interrelated. A common denominator of the above ailments is lower-than-normal testosterone levels occurring in a significant proportion of elderly men. This review addresses the potential connections between LUTS and late-onset hypogonadism. In animal studies there appear to be androgen and estrogen receptors in the urothelium and smooth muscle cells of the urethra and bladder of the rat and rabbit, as well as in the neurons in the autonomic ganglia of the prostatic plexus of the male rat. Upon castration electrically evoked relaxations of the smooth muscle of the prostatic urethra were decreased. There is a Rho-kinase activation/endothelin pathway; possibly involved in the increased smooth muscle activity found in both LUTS/benign prostate hyperplasia. Nitric oxide (NO) appears to have a smooth muscle relaxing effect in the urogenital organs. Studies in humans have convincingly shown that phosphodiestererase inhibitors have a beneficial effect on LUTS. More intervention studies should be undertaken to test the clinical validity of the theoretically plausible interrelationship between LUTS and late-onset hypogonadism.

Neurofibroma de la vejiga: caso clínico y revisión de la literatura

The prevalence of the disease is 1/3000 newborns; it is more frequent in men than in women with a 3:1 ratio in all races. Genitourinary tract neurofibromas usually arise from the pelvic and bladder nerves, and the prostatic plexus. Bladder is the most frequently affected organ of the urinary tract; bladder neurofibromatosis may present as a diffuse infiltrative process or an isolated neurofibroma. Bladder neurofibromas arise from nervous ganglia of the bladder wall and stain positive for protein S-100 and type IV collagen with immunohistochemical techniques. We performed a bibliographic review about urinary tract neurofibromas, and specifically of bladder neurofibroma. We report the case of a 45-year-old female consulting for voiding symptoms and recurrent urinary tract infections. Imaging tests showed a mass in the left lateral wall of the bladder and diffuse thickening of the bladder wall. The thickening of the bladder wall is the most characteristic finding in imaging tests, which may also be present in other diseases such as inflammatory pseudotumor and leiomyoma, so that final diagnosis should be achieved by pathologic study. The case is relevant for the absence of previous diagnosis of neurofibromatosis, being bladder involvement its clinical debut. This is why it was difficult to suspect the final diagnosis: the absence of other characteristic clinical manifestations of the disease. Transurethral resection of the tumor was performed and pathologic and immunohistochemical studies offered the final diagnosis. The patient was followed in the urology clinic and also sent to the internal medicine department to rule out other organs involvement of the disease. Neurofibromatosis is a rare systemic disease, and urinary tract involvement is rarer. Bladder is the most frequently involved organ in the urinary tract, generally as a diffuse infiltration or more rarely a solitary tumor. The final diagnosis is pathological and immunohistochemical. Treatment is usually conservative. The patient should be worked up to rule out other manifestations of the disease, and followed to evaluate the development of new lesions.

Apical block versus basolateral prostatic plexus block in transrectal ultrasound guided prostatic biopsy: A prospective randomized study

<b>OBJECTIVES:</b> We prospectively analyzed the efficacy and safety of apical block, bilateral (B/L) basolateral prostatic plexus block and unilateral (U/L) basolateral prostatic plexus block in patients undergoing transrectal ultrasound (TRUS)- guided prostatic biopsies. <b> MATERIALS AND METHODS:</b> From July 2003 to July 2004, 60 patients of median age 63 yrs and median PSA of15.8 ng/ml, underwent TRUS- guided prostatic biopsies. These biopsies were performed in the left lateral position, after cleansing enema and single dose of antibiotic. Patients were randomized into 3 groups. Under TRUS guidance, group1 (n=20) received 10 ml of 1% lignocaine at the apical area of the prostate, group 2 (n=20) received 5 ml of 1% lignocaine in the basolateral prostatic plexus bilaterally and group 3 (n=20) received 10 ml of 1% lignocaine at basolateral prostatic plexus unilaterally, using an 18 F needle. Five minutes after the injection, a series of 10 prostatic biopsies were performed. Pain during biopsy was assessed using visual analogue pain score. <b> RESULTS:</b> Patients with apical prostatic block had significantly lower pain scores (1.5 ± 0.9) than those with B/L (2.6 ±1.2) and U/L basolateral prostatic plexus block (2.8 ± 1.4). The three groups were similar in regard to age, prostatic volume and number of cores. <b> CONCLUSIONS: </b> Apical prostatic plexus block was the most effective technique and could be a useful alternative to basolateral prostatic plexus block.

1492: Apical Versus Basolateral Prostatic Plexus Block in Transrectal Ultrasonography Guided Prostatic Biopsy: A Prospective Randomized Study

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 25, 2005, 8:00am - 12:00 pm1 Apr 20051492: Apical Versus Basolateral Prostatic Plexus Block in Transrectal Ultrasonography Guided Prostatic Biopsy: A Prospective Randomized Study Anant Kumar, Naval Khurana, and Deepak Dubey Anant KumarAnant Kumar More articles by this author , Naval KhuranaNaval Khurana More articles by this author , and Deepak DubeyDeepak Dubey More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35626-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1492: Apical Versus Basolateral Prostatic Plexus Block in Transrectal Ultrasonography Guided Prostatic Biopsy: A Prospective Randomized Study." The Journal of Urology, 173(4S), p. 404 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 404 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Anant Kumar More articles by this author Naval Khurana More articles by this author Deepak Dubey More articles by this author Expand All Advertisement Loading ...

Optimizing local anesthesia during 10-core biopsy of the prostate

Objectives. To examine, in a prospective, randomized study, the effect of different anesthetic techniques versus no anesthesia in a 10-core prostate biopsy. Reports thus far have shown a high variability in assessing the pain intensity of prostate biopsies and the effectiveness of anesthesia. Methods. Ultrasound-guided 10-core prostate biopsy was performed. Patients were prospectively randomized into four groups: no local anesthesia (group 1); anesthetic block of the prostatic plexus (group 2); local anesthesia onto the capsula of the apex (group 3); and a combination of the anesthesia used for groups 2 and 3 (group 4). The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score. Results. The study included 187 patients. Results were assessed in 170 patients: 44 in group 1, 44 in group 2, 40 in group 3, and 42 in group 4. In group 1 (no anesthesia), 2 (4.5%) of 44 patients had no pain during biopsy (VAS/NAS = 0); the pain was mild (VAS/NAS of 1 to 4) in 38 (86.4%), moderate (VAS/NAS of 4 to 7) in 3 (6.8%), and severe (VAS/NAS of greater than 7) in 1 (2.3%) of 44 patients. The mean pain scores were 2.33 in group 1, 1.68 in group 2 ( P = 0.05), 1.07 in group 3 ( P <0.001), and 1.23 in group 4 ( P <0.001). Pain caused by the local anesthesia itself was 0 in group 1, 1.52 in group 2 ( P = 0.001), 1.05 in group 3 ( P = 0.001), and 1.79 in group 4 ( P = 0.001). Conclusions. Local anesthesia significantly reduces pain. An injection onto the capsule at the apex was the most effective technique. It is technically easier to perform than an anesthetic block of the prostatic plexus and can be recommended.

Differential expression of estrogen receptors α and β in adult rat accessory sex glands and lower urinary tract

Estrogens induce pronounced structural and functional changes in male accessory sex glands and the lower urinary tract in both sexes, but the exact mechanisms of estrogen action are not fully understood. This study was undertaken to localise the tissue cell types that express estrogen receptor in adult rats, and to determine the receptor subtype (ERα and ERβ) in order to identify sites that may respond directly to estrogens. In the male accessory sex glands (seminal vesicles, prostatic lobes and ampullary glands), ERβ mRNA and protein were strongly expressed in the epithelium but not in the stroma, while ERα mRNA was present only in the fibromuscular tissue surrounding the prostatic collecting ducts in the posterior periurethral region and in ampullary gland stroma. In the epithelium of the urinary bladder and urethra of both sexes, high level of ERβ mRNA and protein, but no ERα mRNA, was detected. The connective tissue in urinary bladder of both males and females, as well as that in prostatic urethra in males expressed ERα mRNA. The neural cells in the autonomic ganglia of the prostatic plexus were strongly positive for ERβ mRNA, but were completely devoid of ERα. We conclude that ERβ is the predominant ER subtype in the epithelium of adult male rat accessory sex glands and the lower urinary tract of both males and females, as well as in the prostatic neural plexus regulating the function of the lower urinary tract in males, while ERα is present only in the stromal compartment of distinct sites. These results indicate that in these tissues in intact adults there are multiple targets for direct estrogen action. Furthermore, the differential or complementary expression of the two ER subtypes suggests that they may have specific functions, and may explain the complex structural and functional changes induced by estrogens.

Nerve Block in Prostate Surgery

Purpose We describe a novel technique for anesthetizing the prostate, which should be used for patients at risk undergoing prostate surgery with general, spinal or epidural anesthesia. Materials and Methods Local anesthesia to the prostatic plexus supplemented by monitored anesthesia care was performed on 40 patients with outflow obstruction secondary to an enlarged prostate. Of the patients 34 underwent transurethral resection of the prostate, 5 underwent visual laser ablation and 1 underwent transurethral electrovaporization. A 20 gauge spinal needle was inserted via a suprapubic approach toward the base and apex of the prostate, and guided by the left index finger inserted into the rectum. Lidocaine was injected into the prerectal space. Bulging of the rectal wall caused by the amount of lidocaine injected was appreciated. Insertion into the proper area was essential for a good anesthetic result. Results Adequate anesthesia levels could be obtained without major complications. All but 1 patient with poor bladder compliance were rendered free of a Foley catheter. There were no deaths. Conclusions This technique has definite advantages for patients who are at risk for prostate surgery with general or spinal anesthesia.

Somatostatin receptors in human prostate and prostate cancer.

Benign as well as malignant human prostatic tissues were evaluated for their content of somatostatin (SRIH) receptors (SRIH-R). In vitro receptor autoradiography techniques on cryostat sections were performed using 125I-labeled [Tyr3]octreotide as well as 125I-labeled [Leu8,D-Trp22,Tyr25]SRIH-28 as radioligands. SRIH-R were identified in all normal and hyperplastic prostates in the smooth muscles of the stroma, whereas the glands did not express the receptors. Muscular nodules were strongly receptor positive as well. The receptors were of high affinity (Kd = 0.4 nmol/L) and high specificity for biologically active SRIH analogs; high affinity for SRIH-14, SRIH-28, and octreotide was detected, suggesting the presence of the SSTR2 receptor subtype. In situ hybridization studies confirmed the presence of SSTR2 messenger ribonucleic acid in these tissues. Primary prostate cancers did not have SRIH-R identified with 125I-labeled [Tyr3]octreotide. However, they were expressing SRIH-R identified with 125I-labeled [Leu8,D-Trp22,Tyr25]SRIH-28, with a high affinity for SRIH-14 and SRIH-28, but low affinity for octreotide. The receptors were located on tumoral cells. In situ hybridization studies revealed a preferential expression of SSTR1. Primary human prostate cancers, therefore, express a different SRIH-R subtype than benign prostate tissue. Several veins and the ganglion cells from the prostatic plexus in the surroundings of the tumors were expressing SRIH-R with high affinity for octreotide as well. These data suggest that the human prostate as well as prostate cancers may be targets for SRIH therapy; however, SRIH analogs with different selectivities for SRIH-R subtypes are required in each case.

Control of bilateral seminal emissions from ejaculatory ducts by a lumbar splanchnic nerve

To investigate the route of efferent signals for seminal emissions from ejaculatory ducts (SEEDs), canine lumbar splanchnic nerves (LSNs) were electrically stimulated. SEED was confirmed by visual verification of seminal flow into the exposed posterior urethra. In intact dogs, electrical stimulation of an LSN caused bilateral SEEDs in 13 of 16 dogs examined, with a greater volume at the stimulated side. After transection of a unilateral hypogastric nerve, bilateral SEEDs occurred by electrical stimulation of the contralateral LSN in 11 of 14 dogs with a greater volume at the stimulated side and by the stimulation of the ipsilateral LSN in 13 of 15 dogs with a greater volume at the contralateral side. Contraction pressure of the epididymal tail under the same conditions harmonized with the above results. We conclude that each LSN generates bilateral SEEDs by sending signals to bilateral epididymal tails and that some of the signals through each LSN cross to the other side at the caudal mesenteric plexus and/or the prostatic plexus.

Treatment of impotence caused by veno-occlusive dysfunction with detachable balloons and coils in combination with resection of the deep dorsal vein: comparison with resection of the deep dorsal vein only

A total of 21 patients presenting with impotence due to venous leakage were treated with occlusion of the proximal part of the deep dorsal penile vein and the distal part of the prostatic plexus by way of a radiological intervention technique, i.e. occlusion with detachable balloons and coils. The distal part of the deep dorsal vein was also resected. The follow-up period ranged from 1 to 27 months (mean, 15.3 months). The results of this treatment were compared with the results of resection of the deep dorsal vein alone in 29 patients. Better results were obtained in the balloon-occlusion group, although the differences between the two groups did not reach statistical significance. When the results obtained in the two groups were considered in relation to the amount of leakage, we found no statistically significant difference. The long-term results of venous surgery for veno-occlusive dysfunction are not encouraging, even when more extensive procedures for the prevention of venous outflow are used.

Impotence: Evaluation with Cavernosography

Many patients with organic impotence do not have abnormalities of the penile arterial system. To determine the function of the venous system in erection, cavernosography was performed in 187 impotent men during artificial induction of erection with monitoring of intracavernous pressure and inflow. To evaluate the mechanism of active erection, 69 patients also received intracavernous injections of papaverine. Venous leakage was found in 88 patients. In these patients, a higher than normal rate of flow of diluted, heparinized contrast medium was required to initiate and maintain erection. Opacification of the prostatic plexus also occurred during erection in these patients. In all patients who received papaverine, the flow rates required to initiate and maintain erection decreased. The authors conclude that cavernosography and cavernometry are essential in the work-up of impotence and that papaverine may be helpful in elucidating the active mechanism of erection.