Modified technique for neurovascular bundle preservation during radical prostatectomy: association between technique and recovery of erectile function.
OBJECTIVE
To prospectively evaluate whether a modified surgical technique for neurovascular bundle (NVB) preservation during radical prostatectomy (RP) is associated with an improvement in erectile function (EF) recovery after RP.


METHODS
Data from patients treated before technique modification was used to create a predictive model for EF at 6 months after RP using age, date of surgery, and nerve sparing (none vs unilateral vs bilateral) as predictors for patients who received the modified technique (MT) to estimate the expected outcomes had they received the standard technique (ST), and compared these with actual outcomes. In the MT, the neurovascular bundle (NVB) is completely mobilized off the prostate from the apex to above the seminal vesicles including incision of Denonvilliers' fascia before urethral division and mobilization of the prostate off the rectum.


RESULTS
Of 372 patients with evaluable data, 275 (74%) underwent the ST from 1 January 2001 to 31 December 2004 and 97 (26%) underwent the MT from 1 January 2005 to 30 May 2006. Sixty-five of 97 patients (67%) receiving the MT had EF recovery at 6 months, whereas the expected probability of 6-month recovery of EF, had they received the ST, was 45%. The absolute improvement in EF recovery attributable to the MT was 22% (95% confidence interval 5-40%; P = 0.013).


CONCLUSIONS
Technical modifications to NVB preservation during RP were associated with improved rates of EF recovery.
Masterson
Timothy A
TA
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY10021, USA.
Serio
Angel M
AM
Mulhall
John P
JP
Vickers
Andrew J
AJ
Eastham
James A
JA
D015331:Cohort Studies; D007172:Erectile Dysfunction / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010413:Penis / Q000098:blood supply / Q000294:innervation; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply / Q000294:innervation; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D011471:Prostatic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome