title: Do we need the nerve sparing radical prostatectomy techniques (intrafascial vs. interfascial) in men with erectile dysfunction? Results of a single-centre study.
abstract: OBJECTIVE
  To report effect of different nerve sparing techniques (NS) during radical prostatectomy (RP) (intrafascial-RP vs. interfascial-RP) on post-RP incontinence outcomes (UI) in impotent/erectile dysfunction (ED) men.
  
  
  METHODS
  A total of 420 impotent/ED patients (International Index of Erectile Function-score <15) with organ-confined prostate cancer were treated with bilateral-NS [intrafascial-RP (239) or interfascial-RP (181)] in our institution. Intrafascial-RP was indicated for biopsy Gleason score ≤6 and PSA ≤10 ng/ml while interfascial-RP for Gleason score ≤7 and higher serum PSA. Seventy-seven patients with bilateral non-NS-RP were taken for comparison. No patient received pre-/postoperative radiation/hormonal therapy or had prostatic enlargement surgery. UI was assessed 3, 12 and 36 months postoperatively by third party. Continence was defined as no pads/day, safety 1 pad/day as separate group, 1-2 pads/day as "mild-incontinence" and >2 pads/day as "incontinence".
  
  
  RESULTS
  All groups had comparable perioperative criteria without significant preoperative morbidities. International Prostate Symptom Score showed severe symptoms in 5 % of patients without correlation to UI. UI-recovery increased until 36 months. Full continence was reported from 56 versus 62 and 53 % patients after intrafascial-RP versus interfascial-RP and wide excision at 3 months, respectively (p = 0.521). Corresponding figures at 12 months were 70 versus 61 versus 51 % (p = 0.114) and at 36 months 85 versus 75 versus 65 % (p = 0.135), respectively. After 12 and 36 months, there was tendency to better UI-results in advantage of NS-technique; best results were achieved in intrafascial-RP group. UI-recovery was age-dependant. Advantage was found in NS-group compared with non-NS-group in older patients (>70 years, p = 0.052).
  
  
  CONCLUSIONS
  Impotent/ED patients have higher chances of recovering full continence after NS-RP. NS should be planned independently of preoperative potencystatus whenever technically and oncologically feasible. Age and lower urinary symptoms are not restrictions. Current data should be considered in preoperative patient counselling.
authors.affiliation: Department of Urology, University Hospital-Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany, wael.khoder@med.uni-muenchen.de.
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Raphaela
authors.initials: R
authors.lastname: Waidelich
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Becker
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Stefan
authors.initials: S
authors.lastname: Trittschler
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D007172:Erectile Dysfunction / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D059351:Organ Sparing Treatments / Q000379:methods*; D011184:Postoperative Period; D011467:Prostate / Q000294:innervation* / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology*
references.citation: J Urol. 2008 Dec;180(6):2557-64; discussion 2564
references.pmid: 18930504
references.citation: J Urol. 2000 Sep;164(3 Pt 1):744-8
references.pmid: 10953138
references.citation: N Engl J Med. 2008 Mar 20;358(12):1250-61
references.pmid: 18354103
references.citation: J Urol. 2012 Feb;187(2):569-74
references.pmid: 22177170
references.citation: Eur Urol. 2006 Jan;49(1):38-48
references.pmid: 16332409
references.citation: Eur Urol. 2007 Mar;51(3):648-57; discussion 657-8
references.pmid: 17097214
references.citation: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references.pmid: 20610543
references.citation: BJU Int. 2013 May;111(5):717-22
references.pmid: 22726993
references.citation: Urology. 2010 Sep;76(3):743-8
references.pmid: 20573384
references.citation: BJU Int. 2008 Dec;102(11):1581-4
references.pmid: 18808410
references.citation: Urology. 2013 Dec;82(6):1348-53
references.pmid: 24094657
references.citation: Urol Oncol. 2013 Oct;31(7):1006-11
references.pmid: 22100069
references.citation: J Urol. 2008 Dec;180(6):2527-31
references.pmid: 18930493
references.citation: Eur Urol. 2011 Jan;59(1):61-71
references.pmid: 21056534
references.citation: Eur Urol. 2011 May;59(5):684-98
references.pmid: 21324583
references.citation: J Urol. 2010 May;183(5):1803-7
references.pmid: 20299041
references.citation: Eur Urol. 2011 Nov;60(5):920-30
references.pmid: 21741762
references.citation: Curr Urol Rep. 2010 May;11(3):191-7
references.pmid: 20425626
references.citation: Urology. 2012 Mar;79(3):717-21
references.pmid: 22386427
references.citation: Lancet Oncol. 2011 Sep;12(9):891-9
references.pmid: 21821474
references.citation: J Urol. 2006 Jul;176(1):189-95
references.pmid: 16753399
references.citation: Neurourol Urodyn. 2007;26(1):140-3; discussion 144
references.pmid: 16998858
references.citation: Urology. 1999 Aug;54(2):346-51
references.pmid: 10443736
references.citation: J Endourol. 2006 Nov;20(11):925-9
references.pmid: 17144866
references.citation: Eur Urol. 2010 Feb;57(2):179-92
references.pmid: 19931974