Seminal monolateral nerve-sparing radical prostatectomy in selected patients.
BACKGROUND
In recent years there has been a shift in prostate cancer stage with the majority of patients nowadays being operated with cT1c disease, prostate-specific antigen levels of <10 ng/ml, and a decreased rate of seminal vesicle invasion. Recent data suggest the role of preservation of the seminal vesicle in improving continence and/or potency. We describe our preliminary experience with seminal-sparing, unilateral nerve-sparing retropubic radical prostatectomy.


METHODS
21 selected patients with clinically localized prostate cancer underwent seminal unilateral nerve-sparing retropubic radical prostatectomy (seminal-sparing group, SSG). We compared the postoperative continence, erectile function and quality of orgasm results to those obtained in a control group (CG) of 21 patients who underwent unilateral nerve-sparing radical prostatectomy. Sexual function was evaluated preoperatively and 9 months postoperatively with the 5-item International Index of Erectile Function (IIEF-5) questionnaire and with other self-administered questionnaires. The quality of orgasm was evaluated 9 months postoperatively.


RESULTS
1 month postoperatively, 95 and 28% of the patients in the SSG and CG were continent (p<0.001). The median postoperative drop in IIEF-5 score was 5 points in SSG and 14.5 points in CG (p<0.0001). Nine months postoperatively, 90 and 62% of the patients in SSG and CG, respectively (p=0.05), maintained the ability to achieve orgasm.


CONCLUSIONS
In our experience seminal-sparing radical prostatectomy showed good feasibility and improved early postoperative urinary continence, erectile function and quality of orgasm, without compromised cancer control.
Bellina
Maurizio
M
Division of Urology, Ospedale Degli Infermi, Rivoli, Italy. mauromari@yahoo.com
Mari
Mauro
M
Ambu
Alessandra
A
Guercio
Stefano
S
Rolle
Luigi
L
Tampellini
Marco
M
D000368:Aged; D016022:Case-Control Studies; D007172:Erectile Dysfunction / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D018579:Patient Selection; D011336:Probability; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012016:Reference Values; D018570:Risk Assessment; D012669:Seminal Vesicles / Q000098:blood supply*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control*