The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study

Purpose: We evaluated the somatic and autonomic innervation of the pelvic floor and rhabdosphincter before and after nerve sparing radical retropubic prostatectomy using neurophysiological tests and correlated findings with clinical parameters and urinary continence. Materials and Methods: From February 2003 to October 2005, 46 patients with prostate cancer were enrolled in a controlled, prospective study. Patients were evaluated before and 6 months after nerve sparing radical retropubic prostatectomy using the UCLA-PCI urinary function domain and neurophysiological tests, including somatosensory evoked potential, and the pudendo-urethral, pudendo-anal and urethro-anal reflexes. Clinical parameters and urinary continence were correlated with afferent and efferent innervation of the membranous urethra and pelvic floor. We used strict criteria to define urinary continence as complete dryness with no leakage at all, not requiring any pads or diapers and with a UCLA-PCI score of 500. Patients with a sporadic drop of leakage, requiring up to 1 pad daily, were defined as having occasional urinary leakage. Results: Two patients were excluded from study due to urethral stricture postoperatively. We evaluated 44 patients within 6 months after surgery. The pudendo-anal and pudendo-urethral reflexes were unchanged postoperatively (p = 0.93 and 0.09, respectively), demonstrating that afferent and efferent pudendal innervation to this pelvic region was not affected by the surgery. Autonomic afferent denervation of the membranous urethral mucosa was found in 34 patients (77.3%), as demonstrated by a postoperative increase in the urethro-anal reflex sensory threshold and urethro-anal reflex latency (p <0.001 and 0.0007, respectively). Six of the 44 patients used pads. One patient with more severe leakage required 3 pads daily and 23 showed urinary leakage, including 5 who needed 1 pad per day and 18 who did not wear pads. Afferent autonomic denervation at the membranous urethral mucosa was found in 91.7% of patients with urinary leakage. Of 10 patients with preserved urethro-anal reflex latency 80% were continent. Conclusions: Sensory and motor pudendal innervation to this specific pelvic region did not change after nerve sparing radical retropubic prostatectomy. Significant autonomic afferent denervation of the membranous urethral mucosa was present in most patients postoperatively. Impaired membranous urethral sensitivity seemed to be associated with urinary incontinence, particularly in patients with occasional urinary leakage. Damage to the afferent autonomic innervation may have a role in the continence mechanism after nerve sparing radical retropubic prostatectomy.

A importância das informações aferentes podais para o controle postural

Introduction. The postural control involves a complex mechanism for connecting the afferent and efferent pathways and their integration into the central nervous system (CNS). Three systems are responsible to obtain outside information: visual, vestibular and sensory. Recent studies have shown that among such systems, the CNS shows a greater predilection for sensory information to postural control. Objective. Given this, the review proposes to discuss the feet sensory information importance and its reflection in postural control mechanisms. Method. For this reason, a literature search was carried out by PubMed and Bireme libraries, and papers of the last five years were selected. Specific books were also used. Discussion. Studies were separated into topics on sensory information integration to neuro-motor answer, postural feed-forward adjustments recruitment mechanisms; neuro-muscular coordination and synergy responses and the musculoskeletal tissues role. Conclusion. Despite has been found a large number of studies, the real mechanism that the CNS uses to filter, integrate and process the sensory information and select the appropriate motor response, be it for the movement or posture for the stabilization remains obscure.

Efeito do pré-tratamento com amitraz sobre a febre induzida por lipopolissacarídeo (LPS) de E. coli ou interleucina-1beta (IL-1beta), em coelhos

Pós-graduação em Cirurgia Veterinária - FCAV

The phylogeny and ontogeny of autonomic control of the heart and cardiorespiratory interactions in vertebrates

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The noradrenergic projection from the locus coeruleus to the cochlear root neurons in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)