Preservation of Sexual Function
The anatomical approach to radical prostatectomy has two important goals--the total removal of all tumor and the preservation of quality of life.
At the time of surgery, it is often necessary to remove a wide margin of tissue on the side of the tumor, wider than previously possible. We have
previously shown that it is possible to preserve sexual function even when the nerves (neurovascular bundle) are excised on that side.
Recently we evaulated the return of sexual function in 503 men who were potent before the operation. Overall, 68% were potent following surgery.
Three factors were linked with the return of sexual function: age, pathologic extent of the tumor, and surgical technique (preservation or excision
of the neurovascular bundle). In men under age 50 years, potency was similar in patients who had both neurovascular bundles preserved (90%) and in
patients who had one neurovascular bundle widely excised (91%) (Table 2). With advancing age over 50 years, sexual function was better in patients
in whom both neurovascular bundles were preserved than in patients in whom one neurovascular bundle was excised.
These results indicated that the return of sexual function after surgery in men over age 50 years is measureably related to preservation of nerve
function. That is very exciting news and suggests possibilities for treatment that have never been considered before. For example, in men where it
is necessary to excise the neurovascular bundle on one side, in the future consideration should be given to techniques that may restore autonomic
function through nerve regeneration, e.g. partial excision of the bundle, where possible, or nerve grafts.
TABLE 2. INFLUENCE OF AGE AND PRESERVATION OR EXCISION OF NEUROVASCULAR BUNDLE(S) ON RETURN OF POSTOPERATIVE SEXUAL
FUNCTION IN 503 MEN
|Both nerves intact
|One nerve partially excised
|One nerve widely excised