Minimizing bleeding of dorsal venous complex by artificial erection in a rat model

Minimizar la hemorragia del complejo venoso dorsal mediante erección artificial en un modelo de rata

Background: Bleeding due to dorsal venous complex (DVC) injury is generally regarded as the main cause of stress for the surgeon during radical retropubic prostatectomy (RRP) and radical cystoprostatectomy (RSP). Despite its significance, previous studies have not adequately explored preventive strategies for DVC bleeding. This study aimed to determine whether applying an artificial erection (AE) before transecting the DVC in a rat model could effectively reduce bleeding. Methods: This study was conducted using 10 male Wistar albino rats, aged 16 weeks and weighed between 300 and 350 grams. These rats were randomly divided into two groups: one group underwent artificial erection (AE) before transecting the dorsal venous complex (DVC) (AE+, n = 5), while the other group did not (AE−, n = 5). At the end of the study, we compared the volume of aspirated blood around the transected DVC between the two groups. Results: In the AE− group, an average of 4.28 mL of blood was aspirated (range: 3.8 mL to 4.7 mL), while in the AE+ group, an average of 1.54 mL of sero-hemorrhagic fluid was aspirated (range: 1.4 mL to 1.7 mL). The difference between the two groups was statistically significant (p = 0.009). Conclusions: The results of this study suggest that DVC bleeding caused by DVC transection can be significantly reduced by inducing penile erection using the AE technique in rats. This study lays the groundwork for a novel approach to minimizing DVC bleeding and offers an original contribution to the field, enhancing the understanding and management of DVC bleeding.

Resumen

Antecedentes: La hemorragia debido a una lesión del complejo venoso dorsal (DVC) generalmente se considera la principal causa de estrés para el cirujano durante la prostatectomía radical retropúbica (PRR) y la cistoprostatectomía radical (CPR). A pesar de su importancia, los estudios anteriores no han logrado abordar las estrategias preventivas para la hemorragia por DVC. Nuestro objetivo era determinar si la hemorragia del DVC podría minimizarse aplicando una erección artificial (AE) antes de seccionar el DVC en un modelo de rata. Métodos: El estudio se realizó con 10 ratas albinas Wistar macho, de 16 semanas de edad y con un peso entre 300 y 350 gramos. Estas ratas se dividieron aleatoriamente en dos grupos: un grupo se sometió a una erección artificial (AE) antes de seccionar el DVC (AE+, n = 5), mientras que el otro grupo no (AE−, n = 5). Al final del estudio, comparamos el volumen de sangre aspirada alrededor del DVC seccionado entre los dos grupos. Resultados: En el grupo AE− se aspiraron una media de 4.28 mL de sangre (rango: 3.8 mL a 4.7 mL), mientras que en el grupo AE+ se aspira una media de 1.54 mL de líquido serohemorrágico (rango: 1.4 mL a 1.7 mL) fue aspirado (p = 0.009). Conclusiones: Los resultados de este estudio sugieren que el volumen de hemorragia del DVC debido a la transección del DVC se puede reducir significativamente induciendo la erección del pene con la técnica AE en ratas. Este estudio sienta las bases para un nuevo enfoque para minimizar el hemorragia de DVC y ofrece una contribución original al campo, mejorando la comprensión y el manejo del hemorragia de DVC.

Artificial erection; Bleeding; Corpus cavernosum; Dorsal venous complex; Rat model

Palabras Clave

Erección artificial; Hemorragia; Cuerpo cavernoso; Complejo venoso dorsal; Modelo de rata

[1] Dietrich H. Giovanni Domenico santorini (1681–1737). Charles-Pierre Denonvilliers (1808–1872). First description of urosurgically relevant structures in the small pelvis. European Urology. 1997; 32: 124–127.

[2] Salciccia S, Rosati D, Viscuso P, Canale V, Scarrone E, Frisenda M, et al. Influence of operative time and blood loss on surgical margins and functional outcomes for laparoscopic versus robotic-assisted radical prostatectomy: a prospective analysis. Central European Journal of Urology. 2021; 74: 503–515.

[3] Scarcella S, Castellani D, Gauhar V, Teoh JY, Giulioni C, Piazza P, et al. Robotic-assisted versus open simple prostatectomy: results from a systematic review and meta-analysis of comparative studies. Investigative and Clinical Urology. 2021; 62: 631–640.

[4] Wang Y, Cheng X, Xiong Q, Cheng S. The progress of dorsal vascular complex control strategy in radical prostatectomy. The Journal of International Medical Research. 2023; 51: 3000605231152091.

[5] Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. European Urology. 2021; 79: 243–262.

[6] Memmelaar J. Total prostatovesiculectomy; retropubic approach. The Journal of Urology. 1949; 62: 340–348.

[7] Chute R. Radical retropubic prostatectomy for cancer. The Journal of Urology. 1954; 71: 347–372.

[8] Reiner WG, Walsh PC. An anatomical approach to the surgicalmanagement of the dorsal vein and Santorini’s plexus duringradical retropubic surgery. The Journal of Urology. 1979; 121: 198–200.

[9] Lee HB, Blaufox MD. Blood volume in the rat. Journal of Nuclear Medicine. 1985; 26: 72–76.

[10] Carvalhal GF, Griffin CR, Kan D, Loeb S, Catalona WJ. Reducing blood loss in open radical retropubic prostatectomy with prophylactic periprostatic sutures. BJU International. 2010; 105: 1650–1653.

[11] GBD 2019 Adolescent Young Adult Cancer Collaborators. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Oncology. 2022; 23: 27–52.

[12] Lobo N, Afferi L, Moschini M, Mostafid H, Porten S, Psutka SP, et al. Epidemiology, screening, and prevention of bladder cancer. European Urology Oncology. 2022; 5: 628–639.

[13] Alfred Witjes J, Max Bruins H, Carrión A, Cathomas R, Compérat E, Efstathiou JA, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2023 guidelines. European Urology. 2024; 85: 17–31.

[14] Friederich PW, Henny CP, Messelink EJ, Geerdink MG, Keller T, Kurth KH, et al. Effect of recombinant activated factor VII on perioperative blood loss in patients undergoing retropubic prostatectomy: a double-blind placebo-controlled randomised trial. The Lancet. 2003; 361: 201–205.

[15] Chang SS, Duong DT, Wells N, Cole EE, Smith JA III, Cookson MS. Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. The Journal of Urology. 2004; 171: 1861–1865.

[16] Herranz Amo F. Radical retropubic prostatectomy: control of Santorini’s venous plexus. Actas Urologicas Españolas. 2020; 44: 417–422. (In Spanish)

[17] Dai YT, Stopper V, Lewis R, Mills T. Effects of castration and testosterone replacement on veno-occlusion during penile erection in the rat. Asian Journal of Andrology. 1999; 1: 53–59.