[Clinical experience of nerve-sparing radical prostatectomy]

A total of 18 patients underwent nerve-sparing radical prostatectomy for clinical stage B1 or B2 prostatic cancer. An operation was performed according to the modified technique originally described by Walsh and associates. The operative technique involved three steps: 1) accurate ligation of dorsal vein complex, which makes a relatively bloodless field and makes it possible to dissect the lateral pelvic fascia from the prostate; 2) the incision in the lateral pelvic fascia is made anterior to the neurovascular bundle; 3) the lateral pedicle is divided close to the prostate. There were no major intraoperative complications such as rectal perforation or ureteral injury. The mean blood loss was 802 g (340-1600 g) and the average duration of surgery was 173 minutes. Eleven patients had no blood transfusions. Postoperatively, there was a wound infection in one case. Mild bladder neck contracture in one case responded to single dilatation. Sexual function was evaluated in 16 of the patients who have been followed for more than three months and who had not received hormone therapy postoperatively. Of 16 patients 6 (37%) had return of erectile function. Return of erections required 3-15 months (average 9 months). Patients under 70 years old had a higher incidence (80%) of return of erections than those over 70 years old. Four of the 6 patients had tumor involvement confined to the prostate. Initially most patients had significant amounts of stress incontinence. This resolved within the first or second postoperative month. Finally 4 had slight stress urinary incontinence but no patients had total incontinence. The results suggest that nerve-sparing radical prostatectomy is an anatomically safe approach. It can contribute to the quality of life in men at a stage when it is still curable.