Nerve-sparing laparoscopic radical prostatectomy at Siriraj Hospital.
BACKGROUND
Quality of life after laparoscopic radical prostatectomy has been a discussed issue among patients. Nerve-sparing radical prostatectomy has been shown to be superior to non-nerve-sparing radical prostatectomy in terms of potency and continence. The authors have reported their experience of laparoscopic radical prostatectomy and now developed our technique of nerve-sparing laparoscopic radical prostatectomy.


OBJECTIVE
To evaluate the feasibility of nerve-sparing laparoscopic radical prostatectomy done at our institute.


METHODS
From December 2005 to August 2006, 28 patients with localized prostate cancer underwent a nerve-sparing laparoscopic radical prostatectomy. Perioperative data was compared to those 34 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy during the same period. All patients had PSA of less than 10 and pre-operative Gleason Score of 7 or less. Quality of life including incontinence and impotency rates was analyzed during three months post-operation.


RESULTS
Patients' dermographic data, except ages, was similar in the two groups. Operating time was not different (217 vs. 212 minutes in favor of nerve-sparing). Blood loss was significantly high in nerve-sparing laparoscopic radical prostatectomy (814 mls vs. 543 mls, p = 0.01). Tumor control was not different within both groups. Three months after surgery incontinent rates of both groups were not different. 43.75% of patients with nerve-sparing technique had experienced erection at three months after surgery.


CONCLUSIONS
The authors' early experience has shown that nerve-sparing laparoscopic radical prostatectomy does not compromise cancer control, although blood loss is higher. This operation should be encouraged in cancer-localized patients as the patients may gain benefit of better quality of life.
Srinualnad
Sittiporn
S
Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand. sisri@mahidol.ac.th
Nualyong
Chaiyong
C
D000368:Aged; D007172:Erectile Dysfunction / Q000517:prevention & control; D005240:Feasibility Studies; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D011467:Prostate / Q000294:innervation* / Q000473:pathology; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D012725:Sexual Behavior; D013785:Thailand