Seminal Monolateral Nerve-Sparing Radical Prostatectomy in Selected Patients

Abstract

Introduction: In recent years there has been a shift in prostate cancer stage with the majority of patients nowadays being operated with cT1c disease, prostate-specific antigen levels of <10 ng/ml, and a decreased rate of seminal vesicle invasion. Recent data suggest the role of preservation of the seminal vesicle in improving continence and/or potency. We describe our preliminary experience with seminal-sparing, unilateral nerve-sparing retropubic radical prostatectomy. Patients and Methods: 21 selected patients with clinically localized prostate cancer underwent seminal unilateral nerve-sparing retropubic radical prostatectomy (seminal-sparing group, SSG). We compared the postoperative continence, erectile function and quality of orgasm results to those obtained in a control group (CG) of 21 patients who underwent unilateral nerve-sparing radical prostatectomy. Sexual function was evaluated preoperatively and 9 months postoperatively with the 5-item International Index of Erectile Function (IIEF-5) questionnaire and with oth er self-administered questionnaires. The quality of orgasm was evaluated 9 months postoperatively. Results: 1 month postoperatively, 95 and 28% of the patients in the SSG and CG were continent (p < 0.001). The median postoperative drop in IIEF-5 score was 5 points in SSG and 14.5 points in CG (p < 0.0001). Nine months postoperatively, 90 and 62% of the patients in SSG and CG, respectively (p = 0.05), maintained the ability to achieve orgasm. Conclusions: In our experience seminal-sparing radical prostatectomy showed good feasibility and improved early postoperative urinary continence, erectile function and quality of orgasm, without compromised cancer control.

Cadaveric study of nerves supplying the membranous urethra

“…Sparing the tips of the seminal vesicles in patients who are at minimal risk of seminal vesicle involvement by cancer has been suggested to improve both continence and erections. [13][14][15][16] Our study have confirmed the intimate relationship between the tips of the seminal vesicles and the IHP: the IHP travels along the lateral aspect of the seminal vesicle and forms a surgical plane with seminal vesicle. The seminal vesicle tip-sparing technique avoids any traction and dissection damage to the IHP.…”

Radical Prostatectomy, Sparing of the Seminal Vesicles, and Painful Orgasm

“…Thus, if resection of the tip of the SV is not oncologically necessary, it would seem wise to spare it. However, the benefits and the risks of SV tip preservation are subject to considerable uncertainty [30][31][32][33][34][35]. There are no good estimates of the degree to which SV sparing improves function and similarly we have no good estimates of the degree to which SV preservation increases the risk of recurrence.…”

Comparison of Three Different Tools for Prediction of Seminal Vesicle Invasion at Radical Prostatectomy

“…Some investigators have suggested that sparing the tip of these structures would decrease erectile and urinary dysfunction [6–9]. Three small retrospective studies have demonstrated improved functional outcomes following seminal vesicle-sparing surgery [6–8]. In a fourth study, Albers et al randomly subjected patients with localized prostate cancer either to a seminal vesicle-sparing approach or to a radical prostatectomy with complete seminal vesicle removal.…”