Seminal vesicle sparing laparoscopic radical prostatectomy using a low-energy source: Better continence and potency

Abstract

Objectives:Ongoing with the newer developments in laparoscopic radical prostatectomy (LRP), we report our experience in a consecutive series of 42 patients with a mean 18-month follow-up. We also studied the use of a low-energy source, especially in the region of the prostatic apex and the neurovascular bundle and evaluated its outcome on continence and potency.Materials and Methods:Between November 2003 and December 2008, 50 patients aged 50–80 yrs underwent LRP with vesicourethral anastomosis and of these, 42 patients who had a minimum follow-up of 3 months were selected for the study. Of these, the initial 16 patients were operated by the routine method and the 26 patients operated in the later part of our experience were operated upon using a minimal energy source.Results:The mean follow-up was 18 months (range 3–60). Continence was evaluated at 1, 3, 6, and 12 months. Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II. The difference in continence rates was mainly due to less use of electrocautery and harmonic scalpel at the bladder neck. Of the eight patients who were potent pre-operatively in Group I, four remained potent 3 months after LRP. In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP.Conclusions:Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

Anatomical, surgical and technical factors influencing continence after radical prostatectomy

“…Sectioning the seminal vesicles near the tip would create a larger margin away from the nearby pelvic nerves and theoretically improve continence. 28 Similarly, another study hypothesized that this modification would diminish damage to the NVB, and found superior preservation of continence (95% versus 28%), erectile function (drop of 5 versus 14.5 points on the International Index for Erectile Function (IIEF-5) score), and quality of orgasms (90% versus 62%) compared with the control group. 29 Some argue that the remaining seminal vesicle tissue produces prostate-specific antigen (PSA) and can compromise the validity of post-RP oncologic follow up.…”

Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule

“…The excision of neurovascular bundles causes more incontinence and impotence than when the neurovascular bundles are preserved. 19 To spare the prostatic neurovascular bundles, laparoscopic and robotic-assisted prostatectomy are both useful, 20 because magnification facilitates a more accurate dissection with less traction. 21 Surgically, a midline vertical incision is made into Denonvilliers' fascia—along the entire gland extending up the urethra—and the fascia is sharply retracted to the right and left to expose the posterior prostatic capsule.…”