title: Early release of the neurovascular bundles and optical loupe magnification lead to improved and earlier return of potency following radical retropubic prostatectomy.
abstract: OBJECTIVE
  Since 1999 we have made 2 modifications in the nerve sparing approach to radical retropubic prostatectomy (RRP), namely early release of the neurovascular bundles (NVBs) before division of the posterior membranous urethra and the use of 2.5x optical loupe magnification during NVB preservation. We retrospectively reviewed our results.
  
  
  METHODS
  Between January 1998 and August 2003, 507 men underwent RRP for prostate cancer. All surgeries were performed by a single surgeon (CBB). Bilateral nerve sparing procedures were performed in 313 men. Modifications were introduced sequentially to the surgical technique and potency rates were compared to those of patients operated on before these modifications. Patients were divided into groups based on the technique of nerve sparing as group 1 (standard release of the NVB), group 2 (early release of the NVB) and group 3 (early release with loupe magnification). All patients were followed for a minimum of 5 months. Postoperative potency rates were compared among the 3 groups.
  
  
  RESULTS
  Mean followup was 15.9 months. Mean patient age was 56.2 years. The overall potency rate among groups 1, 2 and 3 was 40.5%, 54.8% and 66.1%, respectively. Mean time to potency was 10.7, 8.5 and 2.0 months, respectively. Significant differences were found in the overall potency rate among all groups (p <0.05). Mean time to potency was significantly improved between groups 1 and 3 (p <0.05) and between groups 2 and 3 (p <0.05).
  
  
  CONCLUSIONS
  Minor modifications in nerve sparing technique lead to improved postoperative potency rates and decreased time to potency in men undergoing RRP.
authors.affiliation: Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois 60637, USA. marc_chuang@sbcglobal.net
authors.forename: Marc S
authors.initials: MS
authors.lastname: Chuang
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
authors.forename: Brett A
authors.initials: BA
authors.lastname: Laven
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Orvieto
authors.forename: Charles B
authors.initials: CB
authors.lastname: Brendler
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D011183:Postoperative Complications / Q000517:prevention & control; D011467:Prostate / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors