Efficacy of Unilateral Nerve Sparing in Radical Perineal ProstatectomyBrehmer B. · Kirschner-Hermanns R. · Donner A. · Reineke T. · Knüchel-Clarke R. · Jakse G.
aUrological Clinic and bDepartment of Pathology, University Clinic, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
Aim: We determine the efficacy of unilateral nerve-sparing radical perineal prostatectomy in preserving the sexual function. Patients and Methods: Ninety-two patients with histologically confirmed unilateral prostate cancer were scheduled for contralateral nerve preservation. The perioperative morbidity was assessed using the patients’ chart reviews. Postoperative health-related quality of life, urinary continence, and potency were evaluated prospectively with questionnaires provided before surgery and then after 6, 12, and 24 months. Results: Unilateral nerve preservation was performed in 88 of the 92 patients. Due to extensive scarring or prostatic size, the procedure was terminated as regular radical prostatectomy in 4 other patients. The perioperative complication rate was low and of minor significance, except in 1 patient who experienced a significant myoglobulinuria due to a prolonged procedure. Blood transfusions were necessary in 5 (5.4%) patients. Ureteral reimplantation was performed in 1 patient because of ureteral stricture. Positive surgical margins were present in 12 (18%) of 67 pT2 patients and in 8 (35%) of 23 pT3 patients. A proportion of 48% (15/31) of the patients followed for more than 24 months and who had a good erectile function prior to surgery reported unassisted sexual intercourse. However, only 4 of these patients were completely satisfied with all aspects of sexual performance, as asked in a short version of the International Index of Erectile Function questionnaire. Conclusions: Unilateral nerve-sparing radical perineal prostatectomy is technically feasible and yields excellent results in terms of potency preservation for prostates <60 ml. However, the quality of erections is decreased, even in patients with erections sufficient for intercourse. Hence, appropriate sexual counseling in conjunction with medical therapy should be offered to all patients.
Prof. Gerhard Jakse
Direktor der Urologischen Klinik, Universitätsklinikum Aachen
DE–52074 Aachen (Germany)
Tel. +49 241 8089374, Fax +49 241 8082441, E-Mail email@example.com
Received: November 25, 2004
Accepted: December 23, 2004
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 5, Number of References : 27
Vol. 74, No. 4, Year 2005 (Cover Date: Released May 2005)
Journal Editor: Hakenberg, O. (Dresden)
ISSN: 0042–1138 (print), 1423–0399 (Online)
For additional information: http://www.karger.com/uin