Bilateral Neurovascular Bundles Sparing Prostatectomy Preserves Sexual Function in Patients with Localized Prostate Cancer

Abstract

The influence of the presence or absence of the neurovascular bundles on patient QOL were examined using the UCLA Prostate Cancer Index (UCLA-PCI) in patients who underwent radical retropubic prostatectomy. The study was performed in 105 patients who were histopathologically diagnosed with prostate cancer and underwent radical retropubic prostatectomy (During prostatectomy, the bilateral neurovascular bundles were preserved in 45 patients (42.8%), unilateral neurovascular bundle preservation was achieved in 24 (22.9%), and no neurovascular bundles were preserved in 36 (34.2%)). The QOL was evaluated before and after surgery using the Japanese edition of the UCLA-PCI, which examines 6 items. Our findings suggested that 'urinary function, 'urinary bother', 'bowel function', and 'bowel bother' deteriorated early after surgery, and recovered to the preoperative levels in the late phase after surgery, but no significant difference was noted in the time-course among the three groups. In contrast, 'sexual function' was significantly improved in the late postoperative phase only in the bilateral nerve-spared group, but not in the unilateral nerve-spared and non-nerve-spared groups. Patients complaining of 'Sexual bother' were more prevalent in the unilateral nerve-spared group in the late postoperative phase, but the difference was not significant. On multiple regression analysis of factors associated with sexual function in the late postoperative phase, only bilateral nerve preservation of was significantly associated with sexual function in the late postoperative phase (p<0.0001). In order to maintain sexual function following radical retropubic prostatectomy, the bilateral neurovascular bundles should be preserved, as far as practicable.