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Vol. 74, No. 4, 2005
Issue release date: May 2005
Urol Int 2005;74:308–314

Efficacy of Unilateral Nerve Sparing in Radical Perineal Prostatectomy

Brehmer 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

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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.

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  1. Paulson DF: Perineal prostatectomy; in Walsh PC, Retik A, Stamey TA, Vaughan ED (eds): Campell’s Urology. Philadelphia, Saunders, 1992, pp 2887–2899.
  2. Weldon VE: Radical perineal prostatectomy; in Das S, Crawford ED (eds): Cancer of the Prostate. New York, Marcel Dekker, 1993, chap 11, pp 225–265.
  3. Frazier HA, Robertson JE, Paulson DF: Radical prostatectomy: The pros and cons of the perineal versus retropubic approach. J Urol 1992;147:888–890.
  4. Para RO: Analysis of an experience with 500 radical perineal prostatectomies in localized prostate cancer (abstract 1265). J Urol 2000;163:284.
  5. Rukstalis DB, Goldknopf JL: Sexual function following a nerve-sparing radical perineal prostatectomy: A case controlled investigation of the CaverMap® surgical aid (abstract). J Urol 2001;165:1107.
  6. Weldon VE, Tavel FR: Potency-sparing radical perineal prostatectomy: Anatomy, surgical technique and initial results. J Urol 1988;140:559–562.
  7. Weldon VE, Tavel FR, Neuwirth H: Continence, potency and morbidity after radical perineal prostatectomy. J Urol 1997;158:1470–1475.
  8. Noldus J, Michl U, Graefen M, Haese A, Hammerer P, Huland H: Patient-reported sexual function after nerve-sparing radical retropubic prostatectomy. Eur Urol 2002;42:118–124.
  9. Huland H, Hübner D, Henke RP: Systematic biopsies and digital rectal examination to identify the nerve-sparing side for radical prostatectomy without risk of positive margin in patients with clinical stage T2, N0 prostatic carcinoma. Urology 1994;44:211–214.
  10. Jakse G, Manegold E, Reineke T, Borchers H, Brehmer B, Wolff JM, Mittermayer C: Die erweiterte radikale perineale Prostatektomie. Urologe A 2000;39:455–462.
  11. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A: The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–830.
  12. Jewett HJ: The results of radical perineal prostatectomy. JAMA 1969;210:324–325.
  13. Weiss JP, Schlecker BA, Wein AJ, Hanno PM: Preservation of periprostatic autonomic nerves during total perineal prostatectomy by intrafascial dissection. Urology 1985;26:160–163.
  14. Harris MJ: Anatomic radical perineal prostatectomy: Cancer control, continence and potency in over 500 patients (abstract). J Urol 2002;167:27628.
  15. Ruiz-Deya G, Davis R, Srivastav SK, Wise A, Thomas R: Outpatient radical prostatectomy: Impact of standard perineal approach on outpatient outcome. J Urol 2001;166:581–586.
  16. Formenti SC, Lieskovsky G, Skinner D, Tsao-Wei DD, Groshen S, Petrovich Z: Update on impact of moderate dose of adjuvant radiation on urinary continence and sexual potency in prostate cancer patients treated with nerve-sparing prostatectomy. Urology 2000;56:453–458.
  17. Litwin MS, McGuigan KA, Shpall AI, Dhanani N: Recovery of health realted quality of life in the year after radical prostatectomy: Early experience. J Urol 1999;161:515–519.
  18. Perez MA, Meyerowitz BE, Lieskovsky G, Skinner D, Reynolds B, Skinner EC: Quality of life and sexuality following radical prostatectomy in patients with prostate cancer who use or do not use erectile aids. Urology 1997;50:740–746.
  19. Walsh PC, Marschke P, Ricker D, Burnett AL: Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 2000;55:58–61.
  20. Gralnek D, Wessells H, Cui H, Dalkin BL: Differences in sexual function and quality of life after nerve sparing and nonnerve sparing radical retropubic prostatectomy. J Urol 2000;163:1166–1170.
  21. Hong EK, Lepor H, McCollough AR: Time dependent satisfaction with sildenafil for erectile dysfunction (ED) after nerve-sparing radical retropubic prostatectomy (RRP). Int J Impot Res 1999;11(Suppl 1):S15–S22.

    External Resources

  22. Rabbani F, Patel MI, Scardino PT: Time course of recovery of potency after bilateral nerve sparing radical prostatectomy (abstract 1178). J Urol 2004;171(suppl):310.
  23. Montorsi F, Briganti A, Salonia A, Rigatti P, Burnett AL: Current and future strategies for preventing and managing erectile dysfunction following radical prostatectomy. Eur Urol 2004;45:123–133.
  24. Catalona WJ, Carvalhal GF, Mager DE, Smith DS: Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999;162:433–438.
  25. Quinlan DM, Epstein JI, Carter BS, Walsh PC: Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles. J Urol 1991;145:998–1002.
  26. Rabbani F, Stapleton AM, Kattan MW, Wheeler TM, Scardino PT: Factors predicting recovery of erections after radical prostatectomy. J Urol 2000;164:1929–1934.
  27. Katz R, Salomon L, Hoznek A, de la Taille A, Vordos D, Cicco A, Chopin D, Abbou CC: Patient reported sexual function following laparoscopic radical prostatectomy. J Urol 2002;168:2078–2082.

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