Nerve-sparing radical prostatectomy: current concepts in a robotic era.
Recovery of potency sufficient for penetrative intercourse at a year after surgery varies widely. Much of the progress achieved in the past two decades in improving potency outcomes after radical prostatectomy has resulted from an improved appreciation of the anatomic basis of the nerves responsible for erection. Recent studies suggest alternative and more complex course of nerves than previously described. Better appreciation of the variable and often invisible anatomical course of the cavernosal nerves continues to engender innovations in surgical technique to optimize their preservation. Exciting frontiers of research that include efforts in stem cell neural regeneration, development of specific fluorophores and biomarkers, and performing radical prostatectomy under hypothermic conditions may provide much-needed breakthroughs to improving potency outcomes following radical prostatectomy in this current age of improved life expectancy and heightened patient expectations.
Lefrak Institute of Robotic Surgery, James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, NY 10065, USA.
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D004564:Electrocoagulation; D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D008297:Male; D009416:Nerve Regeneration; D010413:Penis / Q000294:innervation*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000379:methods*