Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases

In an effort to preserve sexual function, a nerve-sparing technique for radical retropubic prostatectomy has been used in 100 consecutive men with clinically localized prostatic cancer. Each gland was submitted for total histological examination in a way that permitted determination of the extent of the tumor and adequacy of surgical margins. Although 41 patients had established tumor in periprostatic tissue only 7 had positive surgical margins: all 7 had extensive extraprostatic involvement by tumor, while 5 had involvement of the seminal vesicles and none had surgical margins positive only at the site of the nerve-sparing modification. Sexual function was evaluated in 60 of the patients who were potent preoperatively and who have been followed for a minimum of 1 year: 84 per cent of the patients with an intact prostatic capsule were potent compared to 43 per cent with extensive involvement of periprostatic tissue and 33 per cent with involvement of the seminal vesicles or pelvic lymph nodes. Based upon our findings there is no indication that the nerve-sparing modification compromises the adequacy of the removal of the cancer, which is determined primarily by the extent of the tumor rather than the operative technique. Thus, it appears possible to preserve sexual function in a majority of patients undergoing radical prostatectomy without compromising the adequacy of the cancer operation.