Monopolar electrocautery causes pelvic neurovascular injury: a histological and stereological study in rabbits.

Background: Electrosurgical devices are widely employed in penile surgeries for hemostasis and tissue dissection. However, the neurovascular risks associated with monopolar electrocautery, particularly in the context of pelvic innervation and vascular supply, remain unclear. This study investigates the histopathological effects of monopolar versus bipolar electrocautery on pudendal ganglia and prostatic arteries in an experimental model.

Materials and methods: Seventeen male New Zealand rabbits were randomly assigned into three groups: Group I (control, surgical dissection = 5), Group II (bipolar electrocautery = 5), and Group III (monopolar electrocautery = 7). A standardized preputial incision was performed. After a 3-week follow-up, pudendal ganglia and prostatic arteries were excised and analyzed. Degenerated neuron density (DND) and vasospasm index (VSI) were evaluated stereologically. The relatively small sample size (n = 17) represents a methodological limitation and may affect the generalizability of the findings.

Results: Quantitative analyses revealed significantly higher DND and VSI in the monopolar group (DND: 198 ± 37 neurons/mm³; VSI: 2.234 ± 0.987), compared to the bipolar (DND: 31 ± 6; VSI: 1.197 ± 0.120) and control groups (DND: 9 ± 3; VSI: 1.034 ± 0.036), with all comparisons showing statistical significance (p < 0.001). These findings indicate progressive neurovascular injury, most pronounced with monopolar electrocautery.

Conclusions: Monopolar electrocautery during penile surgery induces marked neurovascular injury, potentially impairing pelvic nerve function and vascular regulation. Bipolar cautery is associated with a safer histological profile and should be preferred. Future research should include molecular, functional, and long-term outcome assessments.