September 20, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume I, Spring 1988

Series Reached 500 Patients With Highly Successful Results

The first patient underwent surgery in April 1982 and since then more than 500 patients have followed. They have come from almost every state in the Union and from Israel, Germany, The Netherlands, Italy, Puerto Rico and Iceland. Moreover, urologists from across the nation and around the world have visited Hopkins to learn the operation and now the procedure is being performed at major medical centers worldwide. The surgical technique has been described in detail in medical literature and has been the subject of two movies, one of which recieved the coveted Golden Eagle Award the Council on International Non-theatrical Events. Over the last five years, we have learned much about the surgical technique and have made minor modifications in the procedure.

Overall, 74 percent of the patients have retained potency. Of those who actually were potent, approximately 40 percent were able to resume intercourse within three months after surgery, 58 percent by six months, 70 percent by nine months and 95 percent by one year. During the second year of follow-up, 99 percent of the patients who were eventually potent were successful by 18 months and the final patients achieved success at two years. Most patients experience improvement in sexual function over the next several years following surgery. This should encourage patients who are not yet back to normal.

The return of sexual function correlates with both the age of the patient at the time of surgery and the extent of his disease (Table 1). Potency returned in the two patients in their thirties, in 79 percent of men in their forties, 85 percent of men in their fifties, 64 percent of men in their sixties, but in only 14 percent of men in their seventies. Overall, 74 percent of patients are potent. Based on clinical stage, potency returned in 93 percent of patients with stage AI disease, 72 percent of stage A2, 92 percent of B1 nodules, 72 percent of stage B1 and 56 percent of stage B2 patients. With advancing clinical stage, it is more likely that the tumor extends beyond the prostate, thereby necessitating resection of one or both neurovascular bundles. As a result, one would expect that potency rates would be lower. For example, in virtually all men with stage AI disease, the cancer is confined to the prostate. This suggests that almost all men with clinical stage AI disease should have excellent return of sexual function. Conversely, the reduced rate of potency in men with stage B2 disease indicates that attempts at resection of more advanced tumors result in greater injury to the pelvic nerve plexus.

TABLE 1. INFLUENCE OF AGE AND CLINICAL STAGE ON POSTOPERATIVE POTENCY

Clinical stage* 30-39 40-49 50-59 60-69 70-75 Totals
A1 - found at TUR
involving less than 5% of
the tissue
-
100% 90% 100%
-
93%
A2 - found at TUR
involving more than 5% of
the tissue
-
-
90% 57% 0% 72%
B1 nodule - involving one
lobe surrounded by normal
tissue
100% 80% 97% 92% 0% 92%
B1 - induration involving less
than 1 lobe of prostate
-
79% 82% 65% 20% 72%
B2 - induration involving one
lobe of prostate or more
-
67% 68% 40%
-
56%
Totals 100% 79% 85% 64% 14% 74%

*All patients have normal tissue and bone scan.

We've learned that it is possible to widely excise one neurovascular bundle and maintain potency Sixty-nine percent of men who underwent this procedure with wide excision of one neurovascular bundle are potent postoperatively. We now use the information in Table 1 preoperatively in advising patients, based upon their age and stage of their lesion, as to the likelihood for the postoperative return of sexual function.

 

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