Spremljanje in ocenjevanje erektilne funkcije med robotsko asistirano radikalno prostatektomijo

To optimize the removal of cancerous prostate tissue, nerve-sparing robot-assisted radical prostatectomy (RARP) is commonly used. This technique aims to preserve the neurovascular bundles (NVBs), damage to which is a major cause of postoperative erectile dysfunction (ED). The primary goal of this study was to develop and assess a novel intraoperative NVB stimulation (NVBS) system designed to elicit penile erectile responses during RARP and assist in predicting postoperative erectile function (EF). The stimulation paradigm involved applying trains of rectangular and quasi-trapezoidal stimulating pulses (stimuli) to the apical, mid, and basal portions of the NVBs for approximately 60 s, both before and after the nerve-sparing dissection. The stimulation probe was developed with a consideration of nerve-stimulation models, NVB anatomy, and surgical constraints. Electrodes made of platinum were embedded in denture-grade material and mounted in a titanium housing. To evaluate the erectile responses, a multi-sensor probe was designed to monitor axial penile rigidity (ARIG), galvanic skin response (GSR), and glans temperature Tgp. Additionally, corpus cavernosum electromyography (CC-EMG) was recorded using surface and needle electrodes. Among five male patients enrolled, two showed noticeable CC-EMG activity, but none demonstrated a measurable increase in axial penile rigidity. The CC-EMG data were limited to short-term monitoring and could not be reliably analyzed in the time or frequency domains. In conclusion, although the stimulation protocol did not trigger measurable erectile responses, CC-EMG signals offered intraoperative insights into NVB integrity. This information may support more accurate predictions of erectile function recovery following RARP.