Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function

A total of 52 patients underwent a nerve-sparing radical retropubic prostatectomy for clinical stage A or B prostatic cancer. The incidence of positive surgical margins (18 per cent of the patients with stages A and B1, and 57 per cent with stage B2 disease) was not significantly different (p less than 0.5) from that of 25 patients who underwent a standard radical retropubic prostatectomy by the same surgeon (18 per cent with stages A and B1, and 50 per cent with stage B2 cancer). Of 42 patients who were sexually potent preoperatively 41 (98 per cent) have had partial return of erectile function and 22 (52 per cent) have had return of erections sufficient for vaginal penetration. No correlation between clinical or pathological stage and postoperative potency was observed. Erections sufficient for penetration returned in 67 per cent of the patients less than 60 and 43 per cent of those more than 60 years old. The results suggest that with the nerve-sparing modification of radical retropubic prostatectomy sexual function can be preserved in the majority of patients with clinical stage A or B prostatic cancer without compromising the adequacy of tumor excision.