Sexual Function following Radical Prostatectomy: Influence of Preservation of Neurovascular Bundles

Abstract

The influence of preservation or excision of the neurovascular bundles on return of sexual function is analyzed. Between 1982 and 1988, 600 men 34 to 72 years old underwent radical retropubic prostatectomy for prostate cancer. Of the 503 patients who were potent preoperatively and followed for a minimum of 18 months 342 (68%) are potent postoperatively. Three factors were identified that correlated with the return of sexual function: 1) age, 2) clinical and pathological stage, and 3) surgical technique (preservation or excision of the neurovascular bundle). In men less than 50 years old potency was similar in patients who had both neurovascular bundles preserved (90%) and patients who had 1 neurovascular bundle widely excised (91%). With advancing age of more than 50 years sexual function was better in patients in whom both neurovascular bundles were preserved than in patients in whom 1 neurovascular bundle was excised (p less than 0.05). When the relative risk of postoperative impotence was adjusted for age the risk of postoperative impotence was 2-fold greater if there was capsular penetration or seminal vesicle invasion, or if 1 neurovascular bundle was excised (p less than 0.05). These data indicate that the return of sexual function postoperatively in men more than 50 years old is quantitatively related to preservation of autonomic innervation. In these men when it is necessary to excise the neurovascular bundle on 1 side, consideration in the future should be given to approaches that may restore autonomic function through nerve regeneration, for example partial excision of the bundle or cavernous nerve grafts.

Cavernous nerve graft reconstruction during radical prostatectomy or radical cystectomy: safe and technically feasible

“…Previous animal studies by Quinlan et al and Ball et al using the genitofemoral nerve demonstrated the ability of interposition nerve grafts to recover erectile function in the majority of denervated rats, as measured by mating studies and electric pelvic nerve stimulation. 3,21 Improvement of erectile function was noted at 3 -4 months postoperatively. In humans, however, the procedure is technically more challenging, since the cavernous nerve is not a well-defined structure, but consists of multiple nerves, which are dispersed in a plexus surrounded by vessels.…”

Sexual dysfunction after pelvic surgery

“…The reported potency rates after bilateral nerve-sparing RP in most series varies from 53 to 86%. 4,5,7,8 The current dilemma acknowledging ED following RP is due to wide variation in the potency rates reported in the literature. This variation appears to be dependent not only on the above variables, but also may be due to nonuniformity in data collection.…”

Brachytherapy for prostate cancer in Japan

“…Five-year potency rates after prostate cancer treatment with radical prostatectomy, EBRT and implantation are approximately 40%, 75% and 80%, respectively. 15,17,18 These data suggest that brachytherapy is the best method for prostate cancer treatment from a quality-of-life viewpoint. Our characterization of sexual function with the International Index of Erectile Function (IIEF 15) and nocturnal penile tumescence (NPT) demonstrated that all patients who had undergone brachytherapy using LDR Ir-192 were able to preserve their potency, and 66% maintained their pretreatment ability.…”