Unilateral Nerve Sparing Research Articles

Endoscopic Extraperitoneal Radical Prostatectomy: The University of Leipzig Experience of 2000 Cases

Review of experience with endoscopic extraperitoneal radical prostatectomy (EERPE) for localized prostate cancer. 2000 patients underwent EERPE. Mean age of the patients was 63.2 (41-77) years. Mean preoperative PSA was 10.2 ng/ml (0.64-82 ng/ml). 601 patients had undergone previous surgery. The functional and oncological outcomes were reviewed. Mean operation time was 156 (50-320) min. Complication rate according to Clavien system was: 0.45% intraoperatively, 8.6% in the early and 0.3% in the late postoperative period. Positive surgical margins were found in 127 patients with pT2 stage (9.7%) and in 237 patients with pT3 stage (34.4%). 44/937 lymphadenectomies (4.7%) had positive lymph nodes. Mean catheterization time was 6.3 days. After 12 months, 92% of the patients were completely continent, 7% needed 1-2 pads/day and 1% used more than 2 pads daily.730 patients underwent nerve sparing procedure. The 12 month potency rates with or without administration of PDE 5 inhibitors were 34.1% in the unilateral nerve sparing group and 67.7% in the bilateral group. In the intrafascial nsEERPE group, after 12 months, 93.2% of the patients were completely continent, 7.1% required 1-2 pads per day and 0.6% more than 2 pads per day. Twelve months potency rate for unilateral and bilateral nerve sparing intrafascial procedure was 33.3% and 78.5 % respectively. The rate of positive surgical margins was 6.3% in pT2 and 21.2% in pT3 specimens. Functional and oncological results of this large series are promising. The recently introduced intrafascial nsEERPE further improves the outcome of the procedure.

NERVE GRAFTING AT THE TIME OF RADICAL PROSTATECTOMY: SHOULD WE BE DOING IT?

With increasing numbers of younger men being diagnosed with prostate cancer and subsequently undergoing radical prostatectomy, there is an increasing focus on quality of life postoperatively, especially potency. In patients with locally advanced disease, it has been suggested that use of nerve grafts at the time of radical prostatectomy may improve potency. The technique was first described in 1999 and several papers have been published about its utility. However, there is still controversy over its use because of the lack of any large, blinded trials, the anatomy of the cavernous nerves and the necessity of excising the neurovascular bundles (especially bilaterally). In addition, the results achieved with nerve grafting, a procedure not without significant morbidity and mortality, do not exceed those produced by surgeons carrying out nerve-sparing procedures. In the published work reviewed, erections sufficient to produce vaginal penetration following unilateral nerve grafting (with contralateral nerve sparing) were evident in 41.7-63.6% of patients. This is similar to the rates of 23-64% with unilateral nerve sparing alone. The rates of erectile function sufficient to produce vaginal penetration following bilateral nerve grafting were 34-72%, whereas it is widely accepted that very few men without nerve grafting would have any degree of potency. Currently, there does not appear to be a widespread role for nerve grafting at the time of radical prostatectomy.

Editorial Comment on: Randomized Phase II Trial Evaluation of Erectile Function after Attempted Unilateral Cavernous Nerve-Sparing Retropubic Radical Prostatectomy With Versus Without Unilateral Sural Nerve Grafting for Clinically Localized Prostate Cancer

Abstract Background Nonrandomized studies of unilateral nerve-sparing (UNS) radical prostatectomy (RP) have reported improved recovery of erectile function if the sacrificed cavernous nerve is reconstructed with a sural nerve graft (SNG). Objective To determine whether UNS RP plus SNG results in a 50% relative increase in potency at 2 yr compared to UNS RP alone. Design, setting, and participants The study enrolled patients from October 2001–May 2006 from a single academic center and was randomized, open label. Participants were men with localized prostate cancer recommended for UNS RP, less than 66 yr old, normal baseline erectile function, and willing to participate in early erectile dysfunction (ED) therapy. Patients were followed up to 2 yr. Intervention Patients underwent UNS RP and ED therapy starting at 6 wk: oral prostaglandin type-5 (PDE5) inhibitor, vacuum erection device (VED), and intracavernosal injection therapy. In the SNG group, a plastic surgeon performed the procedure at the time of RP. Measurements The ability to have an erection suitable for intercourse with or without a PDE5 inhibitor at 2 yr. The hypothesis was that SNG would result in a 60% potency rate compared to 40% for controls (80% power, 5% two-way significance). Results and Limitations The trial planned to enroll 200 patients, but an interim analysis at 107 patients met criteria for futility and the trial was closed. For patients completing the protocol to 2 yr, potency was recovered in 32 of 45 (71%) of SNG and 14 of 21 (67%) of controls ( p =0.777). By intent-to-treat analysis, potency recovered in 32 of 66 (48.5%) of SNG and 14 of 41 (34%) of controls ( p =0.271). No differences were seen in time to potency or quality of life scores for ED and urinary function. Limitations included slower-than-expected accrual and poor compliance with ED therapy: Conclusions The addition of SNG to a UNS RP did not improve potency at 2 yr following surgery. Trial Registration ClinicalTrials.gov, Identifier: NCT00080808, http://www.clinicaltrials.gov/ct2/show/NCT00080808?term=NCT00080808&rank=1.

Randomized Phase II Trial Evaluation of Erectile Function after Attempted Unilateral Cavernous Nerve-Sparing Retropubic Radical Prostatectomy With Versus Without Unilateral Sural Nerve Grafting for Clinically Localized Prostate Cancer

BackgroundNonrandomized studies of unilateral nerve-sparing (UNS) radical prostatectomy (RP) have reported improved recovery of erectile function if the sacrificed cavernous nerve is reconstructed with a sural nerve graft (SNG). ObjectiveTo determine whether UNS RP plus SNG results in a 50% relative increase in potency at 2 yr compared to UNS RP alone. Design, setting, and participantsThe study enrolled patients from October 2001–May 2006 from a single academic center and was randomized, open label. Participants were men with localized prostate cancer recommended for UNS RP, less than 66 yr old, normal baseline erectile function, and willing to participate in early erectile dysfunction (ED) therapy. Patients were followed up to 2 yr. InterventionPatients underwent UNS RP and ED therapy starting at 6 wk: oral prostaglandin type-5 (PDE5) inhibitor, vacuum erection device (VED), and intracavernosal injection therapy. In the SNG group, a plastic surgeon performed the procedure at the time of RP. MeasurementsThe ability to have an erection suitable for intercourse with or without a PDE5 inhibitor at 2 yr. The hypothesis was that SNG would result in a 60% potency rate compared to 40% for controls (80% power, 5% two-way significance). Results and LimitationsThe trial planned to enroll 200 patients, but an interim analysis at 107 patients met criteria for futility and the trial was closed. For patients completing the protocol to 2 yr, potency was recovered in 32 of 45 (71%) of SNG and 14 of 21 (67%) of controls (p=0.777). By intent-to-treat analysis, potency recovered in 32 of 66 (48.5%) of SNG and 14 of 41 (34%) of controls (p=0.271). No differences were seen in time to potency or quality of life scores for ED and urinary function. Limitations included slower-than-expected accrual and poor compliance with ED therapy: <65% for VED and <40% for injections. ConclusionsThe addition of SNG to a UNS RP did not improve potency at 2 yr following surgery. Trial RegistrationClinicalTrials.gov, Identifier: NCT00080808, http://www.clinicaltrials.gov/ct2/show/NCT00080808?term=NCT00080808&rank=1.

Impact of nerve sparing on surgical margins and biochemical recurrence: results from the SEARCH database

The effects of nerve sparing on the risk of positive surgical margins (PSMs) and biochemical recurrence after radical prostatectomy (RP) remain controversial. We examined data from 1018 men treated by RP between 1988 and 2006 at five centers in the Shared Equal Access Regional Cancer Hospital database. Neither bilateral nor unilateral nerve-sparing techniques were associated with a higher risk of PSM; on multivariate analysis of individual sides, the risk of PSM on either side was not increased by nerve sparing on either side. The risk for biochemical recurrence was not affected by bilateral or unilateral nerve sparing. When used on appropriately selected patients, nerve sparing does not increase the probability of PSM or biochemical recurrence after RP.

Long-Term Functional and Oncological Outcomes of Patients Undergoing Sural Nerve Interposition Grafting during Robot-Assisted Laparoscopic Radical Prostatectomy

For men with high-volume or high-grade prostate cancer, wide excision of the ipsilateral neurovascular bundle is commonly performed. The concept of nerve reconstruction is intriguing as a feasible approach to preserve sexual function (SF). We sought to evaluate the functional, pathologic, and oncologic outcomes of men who underwent robot-assisted sural-nerve graft (SNG) interposition. Between February 2003 and May 2007, 1175 consecutive men underwent robot-assisted laparoscopic radical prostatectomy (RLRP). Database analysis identified 27 men who had SNG: 4 bilateral (BL) and 23 unilateral (UL). SF was prospectively evaluated preoperatively and at 1, 3, 6, 12, and 24 months postoperatively using validated questionnaires. Positive surgical margins (PSMs), biochemical recurrence (BCR), and potency were evaluated. Compared with RLRP patients without SNG, patients with SNG were younger (57.2 v 61.8 years, P=0.02), had a higher Gleason score (P=0.02), and had a higher clinical and pathologic stage (P<0.001 for both). Mean surgical time was significantly longer (349 v 195 min, P<0.001) in patients with SNG. With a mean follow-up of 26.1 months, 11 (47.8%) patients with UL-SNG and zero men with BL-SNG regained potency. No significant difference in SF was observed between UL nerve sparing and no SNG (56%) compared with UL nerve sparing with UL-SNG (P=0.44). Rates of return-to-baseline SF (RTB-SF) at 6, 12, and 24 months were 11%, 36% and 45% for UL-SNG, respectively, which were also comparable to UL nerve sparing only (P>0.05). No patient (0%) in the BL-SNG group ever achieved RTB-SF status at any time point. PSMs were observed in 37% (10/27) of all patients. BCR occurred in nine patients (33.3%), seven of whom had PSM (78%); treatment failure occurred within 6 months of surgery, necessitating androgen deprivation therapy. Despite optimism regarding SNG, long-term functional outcomes have been disappointing, particularly for BL nerve interposition. UL-SNG functional outcomes do not appear to improve outcomes when compared with men with UL nerve preservation. With the greater risk of PSM and BCR in patients who are considered candidates for SNG, newer treatment modalities are needed to cure their disease while preserving SF.

Laparoscopic Radical Prostatectomy: Reducing the Learning Curve

To review the operative results of a single surgeon after a laparoscopic radical prostatectomy (LRP) fellowship to assess whether the LRP learning curve can be abbreviated. We undertook a prospective study of 50 men who underwent LRP performed by a recently graduated LRP fellowship-trained surgeon. The patient details, operative data, complications, and post-operative followup were collected over the initial 12-month period. The median age was 63 years (range, 47 to 72 years) and median follow-up of 6 months (range, 1 to 12 months). The majority of patients had a preoperative clinical stage T1c (30 = 60%) with a median PSA of 6.4 ng/mL. The median operative time was 225 minutes (range, 160 to 360 minutes) and median blood loss was 400 mL. There were three major complications: 1 anastamotic revision and 2 bladder neck contractures. The positive surgical margin rate for pT2 disease was 5% and for pT3 disease was 20%. Continence rates were 87% at 12 months (no pad use); unilateral (14%) and bilateral nerve sparing (34%) yielded early return of potency in 37.5% of men. No conversions, no rectal injuries, and no deaths occurred in the series. The learning curve that has been observed in other series is not seen with regard to operative time or complication rates. Crucially, it is not seen in a positive surgical margin rate. A dedicated fellowship in laparoscopic radical prostatectomy abbreviates the extensive learning curve for this most technically challenging procedure.

Nerve-Sparing Surgery Significantly Affects Long-Term Continence After Radical Prostatectomy

In this long-term prospective study we evaluated the factors affecting urinary continence after radical prostatectomy. In this study, we recruited 156 patients (mean age, 64.1 +/- 6.7 years; follow-up, 7.8 +/- 1.3 years; prostate-specific antigen [PSA] level, 9.57 +/- 8.81 ng/mL) who underwent radical prostatectomy between 1995 and 1998. Long-term data were obtained on 152 patients, with 4 patients lost to follow-up. Incontinence was evaluated by the number of pads per day. Follow-up data were collected at 3, 6, 12, and 24 months and annually. The multivariate analysis included the following variables: preoperative PSA levels, nerve-sparing (NS) status (bilateral NS, unilateral NS, and non-NS), and age at the time of operation (< or = 65 or > 65 years). With a mean follow-up of 7.8 +/- 1.3 years, the overall incontinence rate was 17.7% (27 of 152). The incontinence rates were significantly higher in the non-NS group (18 of 61) compared with the bilateral NS group (6 of 66; P <0.05). No significant difference was seen between the unilateral NS and non-NS groups in terms of incontinence rates (P >0.05). When stratified by the NS status, the bilateral NS group had a significant improvement in overall continence. The association between age and incontinence was significant: P <0.05 for patients 65 years or younger (7 of 85) versus those older than 65 years (20 of 67). The association between the preoperative PSA levels and incontinence was not significant but showed a trend (the median PSA in the incontinence group was 8.75 ng/mL; in the continence group it was 5.9 ng/mL; P = 0.0534). Nerve-sparing radical prostatectomy improves the time interval to regain continence and long-term continence rates.

Sural Nerve Grafting in Robotic Laparoscopic Radical Prostatectomy: Interim Report

Sural nerve grafting for patients undergoing prostatectomy has been previously reported using open and minimally invasive methods. We report our experience with sural nerve grafting during robot-assisted laparoscopic radical prostatectomy (RLRP). Patients with preoperative potency and a minimum of 6 months follow-up were included in this prospective review. A total of 333 patients were identified between February 2003 and January 2006 who met these criteria including 22 of the 25 patients who underwent sural nerve grafting. Patients were divided into 5 groups to compare unilateral and bilateral sural nerve cohorts with non-nerve-sparing and unilateral and bilateral nerve-sparing groups. Patients were followed prospectively using health-related quality-of-life questionnaires. Twenty-two patients underwent sural nerve grafting that included three bilateral grafts. Mean follow-up was 14 months. There was no statistical difference in patients' ages, body mass index, preoperative prostate-specific antigen level, blood loss, complications, and positive margin rate. Operative time was statistically longer for both sural graft cohorts when compared with unilateral (without graft) and bilateral nerve sparing cohorts. No significant differences in subjective or objective sexual function, sexual bother, or urinary function were seen with 6 and 12 months follow-up, possibly related to smaller sural cohorts. Graft-related complications include leg pain in one patient. Sural nerve grafting during RLRP is technically feasible and safe and offers improved dexterity and visualization deep within the pelvis. However, a larger randomized cohort of patients will be required to validate any improved benefits afforded by the robot system.

The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy

To evaluate the effect of prostate weight on perioperative, functional and oncological outcomes after laparoscopic radical prostatectomy (LRP). Between January 2003 and January 2006, 327 patients had LRP by one surgeon, 193 of whom were available for analysis. Patients were stratified into three groups on the basis of pathological prostate weight, i.e. <or=30, 30-75 and >or=75 g. Perioperative, oncological and functional (continence and potency at 1 year) outcomes were compared among the three groups. Of the 193 patients the prostate was <or=30 g in 18 (9%), 30-75 g in 131 (68%) and >or=75 g in 44 (23%); the mean prostate weight was 27, 49 and 98 g in the three subgroups, respectively. At presentation, 144 patients (75%) had T1c disease, 159 (82%) were potent and 187 (97%) were continent. Unilateral nerve-sparing was done in 37 (19%) and bilateral in 114 (59%) patients. The three subgroups were comparable in age, body mass index, preoperative prostate-specific antigen level, preoperative Gleason score, clinical stage, operative duration, length of hospital stay, duration of catheterization, biochemical recurrence and continence after LRP. In the patients with a prostate of <or=30 g there was a higher incidence of positive margins (39% vs 16% vs 27%; P = 0.03) and inferior 1-year potency (47% vs 75% vs 79%; P =0.04), respectively. Estimated blood loss increased with increasing prostate size (204 vs 256 vs 340 mL; P = 0.01). Prostate size has no effect on continence or biochemical recurrence at 1 year after LRP, but affects intraoperative blood loss, potency and surgical margins. More patients with a longer follow-up are needed to confirm these findings.

Unilateral or bilateral nerve-sparing radical hysterectomy: a surgical technique to preserve the pelvic autonomic nerves while increasing radicality

We performed unilateral or bilateral nerve-sparing (UNS or BNS) radical hysterectomies combined with a parametrial excision in patients with locally advanced cervical cancer. The parametrial excision technique is characterized by a meticulous sharp dissection of the avascular plane outside the visceral fascia of the uterus and vagina under direct vision, providing an en bloc parametria and ensuring that all regional spread of the disease is contained within negative surgical margins. The aim of this study was to describe this surgical technique and to retrospectively evaluate the feasibility and the impact on early bladder function. From February 2005 to November 2006, 32 patients with FIGO stage IB-IIB cervical cancer, who had the tumor of more than 20 mm in diameter, underwent the UNS surgery or BNS surgery. A parametrial excision was performed in all the patients. The surgical procedure was safely completed in all the patients. Though 14 patients had tumor invasion to the parametria, none of the patients had a positive surgical margin in the parametrium. The bladder function of patients in the UNS group immediately after surgery was more damaged than that in the BNS group. However, all the patients in both groups recovered spontaneous voiding with no need of self-catheterization during the perioperative periods. This preliminary study showed that the surgical technique is feasible and safe. For confirmation of the efficacy of this technique, further large prospective studies are needed.

Erectile function following unilateral cavernosal nerve graft

15642 Background: Over the past 20 years, radical prostatectomy has been a mainstay in the treatment of localized prostate cancer. With the adoption of nerve-sparing procedures, select patients may avoid the consequence of erectile dysfunction.Certain patients who are not candidates for nerve-sparing procedures may be eligible for nerve interposition grafts. While bilateral cavernosal nerve grafting after radical prostatectomy has shown efficacy, the effect of unilateral nerve grafting remains unclear. To further ascertain this outcome, we evaluated a large group of patients who underwent a unilateral cavernosal nerve replacement. Methods: Forty patients underwent unilateral nerve sparing surgery with concomitant contralateral cavernosal nerve replacement by a single surgeon from 2002 to 2006. Patient were selected based upon pre-op nomogram risk assessment, endorectal MRI evidence of extra capsular disease or intraop histology demonstrating margin positivity. Age, demographic data, Gleason score, clinical and pathologic stage and pre and post op IIEF data was collected and prospectively analyzed. An additional phone interview was conducted to assess outcomes and morbidity. Results: Full demographic and interview data was available for 28 of 40 patients (70%). Median follow-up was 19 months. The median age at RRP was 53 with a median pre-operative PSA of 6.5. Median pre- and post-op IIEF scores were 25 and 15 respectively. Median change in IIEF scores was 7.5. 22 of 28 patients (79%) men report being able to penetrate after surgery. 17 of those 22 (77%) continue to require PDE-5 inhibitors to facilitate penetration. 3 of the 6 patients (50%) who were unable to have intercourse following nerve replacement received adjuvant hormonal or radiation therapy. 27 patients (96%) reported numbness at the graft harvest site with three (10.7%) describing this as bothersome. One patient experienced a graft site infection and two of 28 (7.1%) patients reported pain at the harvest site. Conclusion: Unilateral sural nerve grafting is a feasible and well-tolerated approach for patients who must undergo wide resection of a neurovascular bundle. While men do show a sizable decrease in their IIEF score, 79% were able to achieve penetration following surgery. The majority of men require PDE-5 inhibitors to facilitate intercourse. No significant financial relationships to disclose.

Results of Unilateral Genitofemoral Nerve Grafts with Contralateral Nerve Sparing During Radical Prostatectomy

To evaluate the success of erectile function preservation and recovery in a select group of patients with extensive disease unilaterally on biopsy who were candidates for unilateral nerve sparing and contralateral genitofemoral interposition nerve-grafting radical prostatectomy (RP). Because of its low donor site morbidity, the genitofemoral nerve is an appealing donor source for cavernous nerve grafting during RP. Although evidence has shown that sural interposition nerve grafts during RP preserve erectile function, the evidence for genitofemoral nerve grafts is limited. Nerve-sparing RP was performed according to the technique of Walsh on 22 patients with prostate cancer. At follow-up, the patients completed an 11-item self-report questionnaire that included the erectile function (EF) domain of the International Index of Erectile Function. The mean patient age was 62 years (range 48 to 76). The mean follow-up time was 23 months (range 9 to 37). Of the 22 patients, 3 reported no erectile dysfunction (ED) (EF score 26 to 30), 3 reported mild ED (EF score 22 to 25), 1 reported moderate ED (EF score 11 to 16), and 15 reported severe ED (EF score less than 11). Eight men continued to experience mild chronic thigh or scrotal numbness after the genitofemoral nerve graft procedure. The benefits of unilateral nerve grafting with the genitofemoral nerve remain uncertain. A prospective randomized trial is warranted before the widespread adoption of unilateral nerve grafting.

Impact of Unilateral Sural Nerve Graft on Recovery of Potency and Continence Following Radical Prostatectomy: 3-Year Longitudinal Study

We conducted a 3-year longitudinal study assessing the impact of unilateral sural nerve graft on recovery of potency and continence following radical prostatectomy. A total of 113 patients undergoing radical retropubic prostatectomy were classified into 3 groups according to the degree of nerve sparing, that is unilateral nerve preservation with contralateral sural nerve graft interposition, bilateral nerve sparing and unilateral nerve sparing. Urinary continence and potency were estimated by the UCLA Prostate Cancer Index questionnaire. Patients in the nerve sparing plus sural nerve graft group were younger than those in the bilateral nerve sparing or unilateral nerve sparing groups. At baseline the unilateral nerve sparing plus sural nerve graft group and the bilateral nerve sparing group reported better sexual function than the unilateral nerve sparing group (62.1 and 61.5 vs 49.9, p<0.05). The bilateral nerve sparing group showed more rapid recovery than the unilateral nerve sparing plus sural nerve graft group after radical retropubic prostatectomy (p<0.01). After 24 months there were no significant differences observed between the bilateral nerve sparing and the unilateral nerve sparing plus sural nerve graft group (28.7 vs 32.9). The bilateral nerve sparing group reported a better sexual function score than the unilateral nerve sparing group throughout the postoperative period (p<0.05). The bilateral nerve sparing group maintained significantly better urinary function at 1 month after radical retropubic prostatectomy than the unilateral nerve sparing plus sural nerve graft group (p <0.05). After 3 months these groups were almost continent. The unilateral nerve sparing group reported lower urinary function scores during the first year compared to the other groups. The nerve graft procedure may contribute to the recovery of urinary function as well as sexual function after radical retropubic prostatectomy. This finding needs to be validated in a randomized trial.

Prostatectomía radical asistida por robot: resultados funcionales

To present a contemporary review of the functional outcomes following robotic-assisted radical prostatectomy based on published postoperative erectile function and urinary continence data. A review of the available literature on Medline and PubMed databases was performed. Factors affecting erectile function include age, preoperative SHIM scores, co-morbidities and nerve sparing techniques. Large robotic-assisted laparoscopic radical prostatectomy (RALP) series like the Vattikuti Institute's and Ohio State University's demonstrate early potency outcomes: 70% and 80% of patients, respectively, who underwent bilateral nerve sparing and had a pre-operative SHIM score > 17, regained potency after a follow-up of 12 months. This has also been reproduced by smaller series, where 43% of patients achieved potency within 3 months postop and 68%, 79% of patients who underwent unilateral or bilateral nerve sparing, respectively, were able to have intercourse with or without PDE5 inhibitors after 12 months follow-up. Postoperative continence rates after RALP for larger series are 76%-92% and 95. 2%-98% while that for smaller series range from 76% and 89% at 3 and 12 months, respectively. RALP is a safe, minimally invasive procedure that produces functional outcomes comparable to contemporary results of both open and laparoscopic prostatectomy.

Do Tumor Volume, Tumor Volume Ratio, Type of Nerve Sparing and Surgical Experience Affect Prostate Specific Antigen Recurrence After Laparoscopic Radical Prostatectomy? A Matched Pair Analysis

We assessed the impact of tumor volume, tumor volume ratio (tumor volume-to-prostate volume), surgical experience and type of nerve sparing procedure on biochemical recurrence after laparoscopic radical prostatectomy. Of 1,600 laparoscopic radical prostatectomies performed between March 1999 and May 2006 we evaluated 555 patients who had at least 24 months of followup and received neither neoadjuvant nor adjuvant therapy. Of 555 patients 81 had biochemical recurrence and were match paired in 3 groups with those without recurrence. Matching decisions were based on factors such as age, preoperative prostate specific antigen, pathological stage, Gleason score, surgical margin status with localization, tumor volume, type of nerve sparing procedure, surgeon and date of operation that are related to surgical experience. We evaluated the impact of tumor volume and tumor volume ratio, type of nerve sparing procedure and surgeon on biochemical recurrence, and excluded the factor being investigated in each matched pair. Tumor volumes were 3.58 vs 3.3 cc and tumor volume ratios were 0.081 vs 0.071 in the biochemical recurrence and no biochemical recurrence groups, respectively (p=0.026 and p=0.040). At the second match pair the numbers of nonnerve sparing, unilateral and bilateral nerve sparing procedures were 65, 12 and 4 vs 62, 13 and 6, respectively, without statistical significance. At the last match pair the volume of cases for the first generation and the other generations were 56 and 25 vs 59 and 22, respectively, also without statistical significance. Although surgical experience based on an adequate training program and type of nerve sparing procedure do not have a significant impact on biochemical recurrence, tumor volume and tumor volume ratio do.

1400: A Randomized Phase II Trial Evaluating the Importance of Early Erectile Dysfunction Rehabilitation and Unilateral Autologous Sural Nerve Grafting in Patients Undergoing a Unilateral Cavernous Nerve Sparing Radical Prostatectomy for Clinically localized PR

You have accessJournal of UrologyModerated Poster 42, Tuesday, May 22, 2007, 1:00 - 3:00 pm1 Apr 20071400: A Randomized Phase II Trial Evaluating the Importance of Early Erectile Dysfunction Rehabilitation and Unilateral Autologous Sural Nerve Grafting in Patients Undergoing a Unilateral Cavernous Nerve Sparing Radical Prostatectomy for Clinically localized PR Christopher G. Wood, David Chang, Run Wang, Yu Shen, Curtis A. Pettaway, Louis L. Pisters, David A. Swanson, Pierre Chevray, S. Wen, Lydia T. Madsen, and Richard J. Babaian Christopher G. WoodChristopher G. Wood More articles by this author , David ChangDavid Chang More articles by this author , Run WangRun Wang More articles by this author , Yu ShenYu Shen More articles by this author , Curtis A. PettawayCurtis A. Pettaway More articles by this author , Louis L. PistersLouis L. Pisters More articles by this author , David A. SwansonDavid A. Swanson More articles by this author , Pierre ChevrayPierre Chevray More articles by this author , S. WenS. Wen More articles by this author , Lydia T. MadsenLydia T. Madsen More articles by this author , and Richard J. BabaianRichard J. Babaian More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31601-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1400: A Randomized Phase II Trial Evaluating the Importance of Early Erectile Dysfunction Rehabilitation and Unilateral Autologous Sural Nerve Grafting in Patients Undergoing a Unilateral Cavernous Nerve Sparing Radical Prostatectomy for Clinically localized PR." The Journal of Urology, 177(4S), p. 461 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 461 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Christopher G. Wood More articles by this author David Chang More articles by this author Run Wang More articles by this author Yu Shen More articles by this author Curtis A. Pettaway More articles by this author Louis L. Pisters More articles by this author David A. Swanson More articles by this author Pierre Chevray More articles by this author S. Wen More articles by this author Lydia T. Madsen More articles by this author Richard J. Babaian More articles by this author Expand All Advertisement PDF downloadLoading ...

940: Penile Rehabilitation after Unilateral Nerve Sparing Radical Prostatectomy with or Without Sural Nerve Grafting: Results of a Prospective Randomized Trial

940: Penile Rehabilitation after Unilateral Nerve Sparing Radical Prostatectomy with or Without Sural Nerve Grafting: Results of a Prospective Randomized Trial

Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 1,300 cases

We herein review our experience with endoscopic extraperitoneal radical prostatectomy (EERPE) as a first line therapy for localized prostate cancer. A series of 1,300 patients underwent EERPE ("wide excision", standard nervesparing technique (nsEERPE), or intrafascial nsEERPE). The mean age of the patients was 63.3 years. Preoperative PSA mean value was 10.1 ng/ml. A total of 415 patients had undergone previous surgical procedure in the lower abdomen (n = 336) and prior surgery of the prostate (n = 79), respectively. The EERPE was employed in all cases without any specific selection criteria. Mean operative time was 153 (50-320) min. including lymphadenectomy with no conversion to open surgery. Seven intraoperative, 91 early and 4 late complications occurred. The transfusion rate was 0.9%. Positive surgical margins were found in 83 patients with pT2 stage (9.8%) and in 154 patients in pT3 stage (34.3%). The mean catheterization time was 6.2 days. The 12 month follow up indicated continence rate of 91.9% and potency rates of 34% in the unilateral nerve sparing group and 69.8% in the bilateral group. In the intrafascial nsEERPE group potency rates were 33.3% (unilateral) and 79.1% (bilateral) after 12 months. Postoperative positive surgical margins rate were 6.1% for pT2 and 20% for pT3 and the complications rate 4%. The results of this large series of 1,300 patients are promising. The recently introduced intrafascial nsEERPE further ameliorates the outcome of the procedure.

Impact of unilateral interposition sural nerve graft on the recovery of sexual function after radical prostatectomy in Japanese men: A preliminary study

To determine the effect of an interposition nerve graft on sexual function after radical prostatectomy. This study includes 64 patients, without hormonal therapy, who underwent a radical prostatectomy and intraoperative electrophysiological confirmation of cavernous nerve preservation. Twelve patients underwent a unilateral interposition sural nerve graft (UNG) for the resected neurovascular bundle. Twenty-one and 31 patients underwent bilateral nerve-sparing (BNS) and unilateral nerve-sparing (UNS) surgery without a nerve graft, respectively. As the age of patients was significantly younger in the UNG group than in the other groups, age-matched analysis also was conducted. Sexual function, evaluated by a self-administered questionnaire using the University of California Los Angeles-Prostate Cancer Index, was compared statistically among the three groups. In the age-matched analysis, the postoperative sexual function (SXF) score of the UNG group showed an intermediate level of recovery between those of the BNS and UNS groups at 12 months and reached the same level as the score at 12 months of the BNS group at 18 months postoperatively. The difference in the SXF score between the UNG and UNS groups began to appear after 6 months postoperatively and increased steadily with time. However, the background factors, such as the baseline SXF score, the usage rate of phosphodiesterase 5 inhibitors, and the rate of comorbidities were different between the UNG and UNS groups. The difference of the SXF score between the UNG and UNS groups increased with time after 6 months postoperatively. However, it might be difficult at present to attribute a better recovery of the SXF score to the nerve graft because of the difference in the background factors between the groups.