Evolution of radical prostatectomy as it pertains to nerve-sparing Journal Article
| Authors: | Yossepowitch, O.; Eastham, J. A. |
| Article Title: | Evolution of radical prostatectomy as it pertains to nerve-sparing |
| Abstract: | Only a few decades ago, radical prostatectomy generally left patients impotent, but today, with the advent of nerve-sparing techniques, many patients can recover sexual function after surgery. We describe our contemporary technique for nerve-sparing during open radical prostatectomy. Key factors include the establishment of a bloodless surgical field prior to dissection of the neurovascular bundles, preservation of any accessory pudendal arteries, avoidance of electrocoagulation in proximity to the neurovascular bundles, and complete mobilization of the neurovascular bundles off the prostate prior to division of the urethra. Resection or partial resection of a neurovascular bundle may be warranted depending on the location of cancer. Estimates of the frequency of recovery of potency after nerve-sparing radical prostatectomy vary greatly, from 21 to 86% of patients. Recovery of potency can take up to 2 years after surgery and is more likely in patients who are younger, who were potent before surgery, and who had both neurovascular bundles preserved. Postoperative potency seems to be increased with the early use of phosphodiesterase-5 inhibitors and intracavernous injection therapy. Potential neuroprotective agents, such as immunophilin ligands, are an area of active research. |
| Keywords: | prostate cancer; prostatectomy; radical prostatectomy; anatomy; surgical; sexual function; technique; impotence; urinary continence; recovery; spontaneous erectile function; accessory pudendal arteries; retropubic; penile; fk506; neurovascular bundles; nerve-sparing surgery; erection; return |
| Journal Title: | Current Clinical Urology |
| ISSN: | 2197-7194 |
| Publisher: | Humana Press Inc |
| Date Published: | 2009-01-01 |
| Start Page: | 69 |
| End Page: | 81 |
| Language: | English |
| ACCESSION: | WOS:000267013600005 |
| PROVIDER: | wos |
| DOI: | 10.1007/978-1-60327-555-2_5 |
| Notes: | Chapter 5 in "Sexual Function in the Prostate Cancer Patient" (ISBN: 978-1-60327-554-5) -- Source: Wos |
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