[Nerve-sparing open radical prostatectomy with extracapsular dissection].
BACKGROUND
Potency recovery after radical prostatectomy (RP) has to be weighed against the risks of nerve-sparing surgery in relation to long-term cancer control.


OBJECTIVE
To apply quality control criteria for RP, define the risk of iatrogenic positive margins and evaluate nerve-sparing dissection and sexual outcomes.


METHODS
Nerve-sparing retropubic RP with "extracapsular" dissection.


METHODS
Histopathology : whole-mount 3-mm serial sections from the prostate apex to base using the Stanford technique. Recovery of erectile function evaluated with the abridged version of the International Index for Erectile Function (IIEF-5).


RESULTS
Prospective study about 507 consecutive RP candidates. Bilateral nerve-sparing (n=273, 88.1%), unilateral (n=37, 11.9%). The risk of iatrogenic positive margins was 5%. The positive surgical margin rate was 6.3% (2.2% for pT2 and 14.5% for pT3). The potency recovery rate with or without type 5 phosphodiesterase inhibitor assistance was 83.5% at 1 year and 95.1% at 2 years.


CONCLUSIONS
Nerve-sparing can be performed in a dissection plane outside the boundaries of the capsule, thus ensuring oncological safety whilst providing highly satisfactory potency recovery rates.
Barré
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Clinique Jules Verne, 2-4 route de Paris, Nantes, France. christianbarre@hotmail.fr
Thoulouzan
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D007172:Erectile Dysfunction / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery