Purpose: We improved intraoperative conditions to achieve better corpora cavernosal response to stimulation of the erectile nerves.
Materials and methods: A total of 18 men undergoing nerve sparing retropubic prostatectomy were evaluated with intraoperative stimulation for identification of the erectile nerves. Intracavernosal pressure was measured directly or via electromyography of the corpora cavernosa. Different kinds of anesthesia were used with or without urapidil.
Results: Intracavernosal pressure was recorded in all patients. Use of isoflurane based anesthesia blocked change, and total intravenous anesthesia with propofol resulted in a measurable change in intracavernosal pressure during electrostimulation. However, local urapidil, a potent alpha-blocking agent, doubled or tripled intracavernosal pressure. Electromyography of the corpora cavernosa demonstrated no measurable change.
Conclusions: Intraoperative electrostimulation of erectile nerves requires special anesthesia as well as local blocking of alpha-receptors. The functional anatomy of the erectile nerves is variable.