Nerve detector that could save a man from incontinence and impotence
02:28 GMT, 24 July 2012
A ‘nerve-spotter’ is being tested as a way to reduce nerve damage during surgery.
The device works like a mine-sweeper, detecting the location of crucial nerves buried in the tissue and invisible to the eye — enabling surgeons to avoid accidentally severing them.
Doctors are now trialling it in prostate surgery to reduce post-operative incontinence and impotence.
It's estimated around 30 per cent of prostate cancer patients suffer some degree of erectile dysfunction after a prostatectomy
It’s estimated around 30 per cent of prostate cancer patients suffer some degree of erectile dysfunction after a prostatectomy (prostate gland removal).
This is usually a result of damage to two sets of nerves next to the prostate gland.
One set controls sexual functioning and the other continence.
In some cases, these side-effects are temporary, but in around 20 per cent of patients they can last for up to two years or longer.
At the moment, surgeons have relatively unsophisticated ways of avoiding the nerves, relying on anatomical ‘signposts’ such as the seminal vesicles (tiny sacs at the back of the prostate gland) and their judgment.
The problem is that anatomical markers vary with each man.
The new device, called the ProPep Nerve Monitoring System, helps the surgeon monitor the position of the nerves.
Two wire-like electrodes are placed in the tissue around the prostate and urethra (the tube that carries urine from the bladder). These electrodes are connected to an external monitor.
The electrodes emit a small electrical current.
The speed at which this current passes through the tissue shows if there is a nerve there.
This is because nerves, unlike tissue, are highly efficient carriers of electricity.
When nerves are detected, the electrodes produce a special type of warning signal, displayed on the monitor for the surgeon to see during the operation.
Nerve monitoring is already used in some spinal and brain operations, and surgeons are increasingly employing devices such as these for other types of procedures, such as facial and thyroid operations.
'Surgeons welcome anything that will help pinpoint the nerves to give better outcomes for sexual function and continence,' said Professor Raj Persad
However, this is the first device to be produced for prostate procedures.
It has been developed for robot-assisted prostate surgery, although the developers believe it could be used for other robot-assisted operations, such as joint replacements, hysterectomy and face and throat surgery.
The ProPep has now been approved for use in the UK.
Commenting on the device, Professor Raj Persad, urological surgeon at the Bristol Royal Infirmary and Bristol Urological Institute, said: ‘This looks like a good idea and has potential for enhancing the quality of life of thousands of men who have this procedure every year.
'Surgeons welcome anything that will help pinpoint the nerves to give better outcomes for sexual function and continence.
‘This one is made for the robot — which is increasingly the method by which prostate surgery is performed — but I am sure it can be used during open surgery as well.’
Scientists have developed tiny plastic tubes that could act as a type of ‘flower trellis’ to help repair nerves in limbs damaged through injury and disease.
The tubes have been shown to help nerves grow by 1mm a day and restore sensation and movement in injured limbs.
It’s estimated around 60,000 people a year in the UK suffer a peripheral nerve injury, which can be caused by anything from a kitchen knife cut to car crash injuries.
And around six in ten people with diabetes have diabetic neuropathy, nerve damage caused by uncontrolled blood-glucose levels.
Nerves are hard to repair, but one option surgeons use is to graft damaged areas together.
However, nerves are very complex structures — each is a bundle of fibres, like an electrical wire — and often don’t connect correctly.
Professor John Haycock, part of the team who have developed the tubes, explains: ‘When nerves in the arms or legs are injured, they have the ability to re-grow (unlike in the spinal cord, which reacts in a different way to trauma) but need assistance.’
The devices are made from biodegradable materials and are designed to guide the growing nerves, much like a trellis directs the growth of climbing flowers.
In laboratory experiments, nerve cells added to the conduit grew naturally. The research team are planning clinical trials.