title: Curtain dissection of the lateral prostatic fascia and potency after laparoscopic radical prostatectomy: a veil of mystery.
abstract: OBJECTIVE
  To assess the effect on potency recovery of incorporating a high incision of the lateral prostatic fascia (LPF) or curtain dissection (CD) into our technique of laparoscopic nerve-sparing radical prostatectomy (LNSRP).
  
  
  METHODS
  In all, 137 bilateral neurovascular bundle (NVB) preserving LNSRPs were performed, incorporating curtain dissection (CD) of the LPF. Potency was assessed at 1, 3, 6 and 12 months using validated questionnaires and compared with a control group (CG) of standard NVB preservation.
  
  
  RESULTS
  There were no conversions to open surgery in either group. The median operative duration in the CD group and the CG was 178 min and 174 min (P = 0.04), blood loss was 300 mL and 200 mL (P = 0.01), and the positive margin rate was 16.1% and 24.1% (P = 0.04), respectively. At a mean follow-up of 5.8 months in the CD group and 28.2 months in the CG, potency rates were 21.1% and 8.8% at 1 month (P = 0.01), and 68.4% and 67.2% at 12 months (P = 1.00), respectively.
  
  
  CONCLUSIONS
  The potency rate was significantly higher in the CD group at 1 month than in the CG, thereafter the rates were similar between the groups. We think that the merit of this technique is in improved visualization of the basal prostatic contour during antegrade NVB dissection, rather than preserving important nerve fibres. This may explain the lower basal positive margin rate in the CD group of 0% vs 5.8% in the CG (P = 0.007).
authors.affiliation: Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK. c_chabert@hotmail.com
authors.forename: Charles C
authors.initials: CC
authors.lastname: Chabert
authors.forename: David A
authors.initials: DA
authors.lastname: Merrilees
authors.forename: Mischel G
authors.initials: MG
authors.lastname: Neill
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Eden
mesh_terms: D016022:Case-Control Studies; D004210:Dissection; D007172:Erectile Dysfunction / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011467:Prostate / Q000098:blood supply / Q000294:innervation; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome