Sparing Potency, Sparing Nerves with Laparoscopic Prostatectomy
The Brady's Laparoscopic Radical Prostatectomy (LRP) Program is the new kid on the block, and it's coming on strong. In just four years, there's been a 15-fold increase in the number of operations performed by the program's two surgeons, Li-Ming Su, M.D., associate professor of urology and director of Pelvic Laparoscopy and Stone Disease at the Johns Hopkins Bayview Medical Center,and Christian Pavlovich, M.D., associate professor of urology and director of Urologic Oncology at Bayview. "So far, we've performed more than 500 successful LRPs,"says Su, "and we anticipate that we will be performing more than 200 a year."
In a recent study of the return of sexual function in their LRP patients, Su and Pavlovich found that - as is the case with the "nerve-sparing" retropubic procedure pioneered by Patrick C. Walsh, M.D. - men who had both of the nerve bundles (one on either side of the prostate, these bundles contain the nerves responsible for erection) spared had better potency results than men who had only one nerve bundle spared. "At one year after surgery, 72 percent of our patients who underwent bilateral (both sides) nerve-sparing surgery reported the ability to engage in intercourse," with or without the use of drugs such as Viagra, reports Su. However, when only one nerve was spared, 35 percent were potent at one year.
Younger men, too - men in their fifties -were more likely to recover potency than older men. Su found that younger men who received nerve-sparing LRP reported a higher potency rate of 74 percent, as compared to 41 percent of older men at one year after surgery. And of the men younger than 58 who had both nerve bundles spared, 82 percent reported successful intercourse at one year.
Su and Pavlovich are continually working to improve their results in this still-new area of surgery. From laboratory work with animals this year, they have found that the delicate nerve bundles are sensitive even to heat. "We have modified our technique to avoid the use of thermal energy sources when dissecting the fine cavernous nerve bundles, just like in open surgery," explains Su.
Su has specially designed fine-tipped laparoscopic instruments that allow him to "meticulously dissect and preserve the fragile nerve fibers, while removing the cancerous prostate. We clearly have learned a great deal from the surgical principles defined by the anatomic nerve-sparing radical retropubic
prostatectomy approach described by Dr.Patrick Walsh," he adds, "and we're simply applying these principles to our laparoscopic technique."
Preserving the nerves - and potency -during LRP is a skill that comes with experience, says Su, and with their vigilant efforts to improve the procedure, the results are getting better all the time. "In our last 50 patients, more than 90 percent of men received successful nerve-sparing surgery, with both nerves preserved in 72 percent of men. This is in contrast to the first 50 LRPs, where only 50 percent of men received successful bilateral nerve-sparing surgery."