The impact on sexual function after nerve sparing and non-nerve sparing radical retropubic prostatectomy

We examine the impact of nerve sparing technique on the sexual function after radical retropubic prostatectomy for localized prostate cancer.

Between March, 1996 and September 2000, 44 men with clinically localized adenocarcinoma of the prostate who underwent radical retropubic prostatectomy (RRP) were included in this study. The mean age of these patients was 68.7 +/- 4.5 years old (range: 57-75). Among them, 8 patients were impotent preoperatively, 18 patients did not undergo nerve sparing surgery due to technical difficulties, and the remaining 18 potent patients underwent nerve sparing RRP. The postoperative sexual function was assessed by the International Index of Erectile Function (IIEF-6) and patient-reported percentage of recovery of sexual function.

Mean length of follow-up was 14.4 +/- 2.7 months (range 12-18). The IIEF scores and % recovery of sexual function were significantly higher in nerve sparing surgery when compared to that of non-nerve sparing surgery (15.2 +/- 9.0 vs. 2.0 +/- 3.8 and 55 +/- 30% vs. 3 +/- 10%, respectively, p < 0.001). Of the 18 potent patients who underwent nerve sparing surgery, spontaneous erection and successful sexual activity was reported in 4 (22.2%) patients. Eight (44.4%) patients could achieve intercourse either with the aid of sildenafil or intracavernous alprostadil injection. Four (22.2%) patients had partial erection but refused further treatment. Two (11.1%) patients were completely impotent after nerve sparing surgery. Postoperative PSA was 0.10 +/- 0.18 (range 0.01-0.59).

After a mean length of 14.4 months' follow-up, a majority of our patients could achieve sexual activity, and the cancer control following nerve sparing surgery was good. Our results suggest that nerve sparing retropubic radical prostatectomy is indicated in selected patients with localized adenocarcinoma of the prostate.