title: Bilateral vs unilateral laparoscopic intrafascial nerve-sparing radical prostatectomy: evaluation of surgical and functional outcomes in 457 patients.
abstract: Study Type - Therapy (case series).
  
  
  METHODS
  4. What's known on the subject? and What does the study add? Bilateral nerve-sparing radical prostatectomy still represents an issue for urologists as the indications to perform it depend oft from the personal clinical experience. Moreover, until now data concerning bilateral and unilateral laparoscopic nerve-sparing radical prostatectomy have been limited. This study states that bilateral laparoscopic intrafascial nerve-sparing technique results in superior functional outcomes when compared with unilateral nsLRP and it suggests to prefer a bilateral nerve-sparing technique in younger patients with low-risk, organ-confined prostate cancer.
  
  
  OBJECTIVE
  To evaluate the surgical and functional outcomes in bilateral and unilateral nerve-sparing laparoscopic radical prostatectomy (nsLRP).
  
  
  METHODS
  Between January 2005 and May 2009, 457 nsLRP were performed at our clinic. In all, 250 patients underwent a bilateral nsLRP and 207 patients underwent an unilateral nsLRP. One surgeon performed all the operations. All patients presented at biopsy a localized prostate cancer. Demographic data and perioperative and postoperative measurements and outcomes were compared.
  
  
  RESULTS
  The operative times for bilateral nsLRP and unilateral nsLRP were 165 ± 45 min and 130 ± 25 min, respectively. The mean intra-operative blood loss was 450 ± 300 mL and 270 ± 160 mL in the bilateral and unilateral nsLRP groups with a transfusion rate of 3% and 1%, respectively (P = 0.013). Conversion to open surgery was never deemed necessary. Postoperatively, the mean Gleason Score after nsLRP and distribution of tumour stages was similar in the two groups, and the frequency of positive margins in both groups did not present any statistically significant difference. At 12 months, a complete continence was reported in 97% of patients who underwent a bilateral nsLRP and in 88% of patients of the unilateral nsLRP group. At that time, 69% in the bilateral nsLRP and 43% in the unilateral nsLRP groups reported the ability to engage in sexual intercourse.
  
  
  CONCLUSIONS
  The bilateral laparoscopic intrafascial nerve-sparing technique results in superior functional outcomes with regard to urinary continence and sexual potency, when compared with unilateral nsLRP, reporting similar oncological outcomes.
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle-Wittenberg, Germany. francesco.greco@medizin.unihalle.de
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: M Raschid
authors.initials: MR
authors.lastname: Hoda
authors.forename: Sigrid
authors.initials: S
authors.lastname: Wagner
authors.forename: Olaf
authors.initials: O
authors.lastname: Reichelt
authors.forename: Antonino
authors.initials: A
authors.lastname: Inferrera
authors.forename: Carlo
authors.initials: C
authors.lastname: Magno
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control; D005240:Feasibility Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D020196:Trauma, Nervous System / Q000517:prevention & control*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control