title: Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy.
abstract: OBJECTIVE
  Based on our recently published anatomic studies, we present the most recent refinement of the endoscopic extraperitoneal radical prostatectomy (EERPE), the intrafascial nerve-sparing EERPE (nsEERPE).
  
  
  METHODS
  As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule, freeing the prostate laterally from its thin surrounding fascia that contains small vessels and nerves. The technique enables puboprostatic ligament preservation, leaving intact endopelvic fascia, periprostatic fascia, and neurovascular bundles. The operation was performed in 150 patients with indications for nerve-sparing procedure.
  
  
  RESULTS
  The mean operative time was 131 min (range: 50-210 min) and the mean catheterization time was 5.9 d (range: 4-20 d). Twelve months postoperatively, 94.3% of the patients were continent (no need for pads), 4.6% had minimal stress incontinence, and one patient required >2 pads/d. At the 12-mo follow-up, the potency rates (erections sufficient for intercourse with or without the use of phosphodiesterase 5 [PDE5] inhibitors) of the patients who underwent bilateral intrafascial nsEERPE were 89.7% (age: 44-55 yr), 81.1% (age: 56-65 yr), and 61.9% (age: >65 yr). Positive surgical margins in pT2 and pT3 tumors were 4.5% and 29.4%, respectively.
  
  
  CONCLUSIONS
  The intrafascial nsEERPE enables the dissection of the prostate with limited trauma to the surrounding fascias and the enclosed neurovascular bundles. We propose that the preserved neurovascular bundles with intrafascial nsEERPE are more viable. The results advocate this proposition.
authors: Department of Urology, University of Leipzig, Leipzig, Germany. stolj@medizin.uni-leipzig.de
authors: Jens-Uwe
authors: JU
authors: Stolzenburg
authors: Robert
authors: R
authors: Rabenalt
authors: Minh
authors: M
authors: Do
authors: Thilo
authors: T
authors: Schwalenberg
authors: Mathias
authors: M
authors: Winkler
authors: Anja
authors: A
authors: Dietel
authors: Evangelos
authors: E
authors: Liatsikos
mesh_terms: D000328:Adult; D000368:Aged; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D000071938:Fasciotomy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011467:Prostate / Q000294:innervation* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation / Q000601:surgery; D014549:Urinary Incontinence / Q000517:prevention & control