PURPOSE OF REVIEW: Although cure of prostate cancer is the primary goal of radical prostatectomy, preserving erectile function is also tantamount, given the indolent clinical course of most prostate cancers, particularly low-risk disease.
In order to optimize postprostatectomy erectile function during a robotic-assisted radical prostatectomy, there must be a detailed understanding of pelvic anatomy to recognize the optimal nerve-sparing plane and technical finesse to minimize stretch injury to the neurovascular bundle.
RECENT FINDINGS: The magnified, well illuminated robotic-operative field coupled with less blood loss has paralleled greater understanding of the periprostatic 'fascial' planes, leading to differentiation of intrafascial versus interfascial nerve-sparing approaches. However, refinement of tissue handling during nerve-sparing to minimize lateral displacement of the neurovascular bundle and attenuate neurapraxia enables earlier and better recovery of erectile function.
SUMMARY: The critical maneuvers to preserving erectile function are atraumatic dissection of the prostate away from the optimal nerve-sparing plane to maximally preserve nerve fibers while minimizing neurapraxia. Therefore, attaining these principles involves a conceptual paradigm shift from 'radical' prostatectomy to neurosurgery of the prostate.
Written by:
Carter S, Le JD, Hu JC. Are you the author?
Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
Reference: Curr Opin Urol. 2013 Jan;23(1):88-94.
doi: 10.1097/MOU.0b013e32835b6602
PubMed Abstract
PMID: 23169152
UroToday.com Endourology Section
