title: Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy.
abstract: OBJECTIVE
  Although cure of prostate cancer is the primary goal of radical prostatectomy, preserving erectile function is also tantamount, given the indolent clinical course of most prostate cancers, particularly low-risk disease. In order to optimize postprostatectomy erectile function during a robotic-assisted radical prostatectomy, there must be a detailed understanding of pelvic anatomy to recognize the optimal nerve-sparing plane and technical finesse to minimize stretch injury to the neurovascular bundle.
  
  
  RESULTS
  The magnified, well illuminated robotic-operative field coupled with less blood loss has paralleled greater understanding of the periprostatic 'fascial' planes, leading to differentiation of intrafascial versus interfascial nerve-sparing approaches. However, refinement of tissue handling during nerve-sparing to minimize lateral displacement of the neurovascular bundle and attenuate neurapraxia enables earlier and better recovery of erectile function.
  
  
  CONCLUSIONS
  The critical maneuvers to preserving erectile function are atraumatic dissection of the prostate away from the optimal nerve-sparing plane to maximally preserve nerve fibers while minimizing neurapraxia. Therefore, attaining these principles involves a conceptual paradigm shift from 'radical' prostatectomy to neurosurgery of the prostate.
authors.affiliation: Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Carter
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Le
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011467:Prostate / Q000033:anatomy & histology / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012371:Robotics / Q000379:methods*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome