Alternative Approaches to Nerve Sparing: Techniques and Outcomes

  • Can Öbek
  • Ali Rýza Kural


The preservation of sexual potency after prostatectomy has always been the topic of much anxiety and debate. While cancer control and urinary continence are of supreme importance, the preservation of sexual function completes the trifecta that both patient and surgeon strive to achieve. Over the decades open nerve sparing radical prostatectomy has continued to evolve from its early rudimentary beginnings into the more refined techniques that we see today. However, while we have seen considerable advances in recent times the limitations in visualization and dissection of the bundle have continued to provide a challenge to even the most experienced surgeon.


Radical Prostatectomy Erectile Function Sural Nerve Radical Retropubic Prostatectomy Laparoscopic Radical Prostatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 1983;4:473–485.PubMedCrossRefGoogle Scholar
  2. 2.
    Ong AM, Su LM, Varkarakis L, et al. Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model.Google Scholar
  3. 3.
    Ahlering TE, Eichel L, Skarecky D. Early potency outcomes with cautery-free neurovascular bundle preservation with robotic laparoscopic radical prostatectomy. J Endourol 2005;19:715–718.PubMedCrossRefGoogle Scholar
  4. 4.
    Donzelli J, Leonetti JP, Wurster RD, et al. Neuroprotection due to irrigation during bipolar cautery. Arch Otolaryngol Head Neck Surg 2000;126:149–153.PubMedGoogle Scholar
  5. 5.
    Chien GW, Mikhail AA, Orvieto MA, et al. Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. Urology 2005;66:419–423.PubMedCrossRefGoogle Scholar
  6. 6.
    Kursh ED, Bodner DR. Alternative method of nerve sparing when performing radical retropubic prostatectomy. Urology 1988;32:205–209.PubMedCrossRefGoogle Scholar
  7. 7.
    Guillonneau B, Vallencien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 2000;163:1643–1649.PubMedCrossRefGoogle Scholar
  8. 8.
    Kiyoshima K, Yokomizo A, Yoshida T, et al. Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 2004;34(8):463–468.PubMedCrossRefGoogle Scholar
  9. 9.
    Kaul S, Bhandari A, Hemal A, Savera A, Shrivastava A, Menon M. Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology 2005;66(6):1261–1265.PubMedCrossRefGoogle Scholar
  10. 10.
    Menon M, Kaul S, Bhandari A, et al. Potency following robotic radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol 2005;174:2291–2296.PubMedCrossRefGoogle Scholar
  11. 11.
    Menon M, Shrivastava A, Tewari A. Laparoscopic radical prostatectomy: conventional and robotic. Urology 2005;66(suppl 5A):101–104.PubMedCrossRefGoogle Scholar
  12. 12.
    Ahlering TE, Eichel L, Chou D, et al. Feasibility study for robotic radical prostatectomy cauteryfree neurovascular bundle preservation. Urology 2005;65:994–997.PubMedCrossRefGoogle Scholar
  13. 13.
    Gill IS, Ukimura O, Rubinstein M, et al. Lateral pedicle control during laparoscopic radical prostatectomy: refined technique. Urology 2005;65: 23–27.PubMedCrossRefGoogle Scholar
  14. 14.
    Ukimura O, Gill IS, Desai MM, et al. Real-time transrectal ultrasonography during laparoscopic radical prostatectomy. J Urol 2004;172:112–118.PubMedCrossRefGoogle Scholar
  15. 15.
    Maccabee MS, Trune DR, Hwang PH. Effects of topically applied biomaterials on paranasal sinus mucosal healing. Am J Rhinol 2003;17:203–207.PubMedGoogle Scholar
  16. 16.
    Quinlan DM, Epstein JI, Carter BS, et al. Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 1991;145:998–1002.PubMedGoogle Scholar
  17. 17.
    Kim ED, Nath R, Kadmon D, et al. Bilateral nerve graft during radical retropubic prostatectomy: 1-year followup. J Urol 2001;165:1950–1956.PubMedCrossRefGoogle Scholar
  18. 18.
    Turk I, Deger S, Morgan WR, et al. Sural nerve grafting during laparoscopic radical prostatectomy. Initial experience. Urol Oncol 2002;7:191–194.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim ED, Scardino PT, Hampel H, et al. Interposition of sural nerve restores function of cavernous nerves resected during radical prostatectomy. J Urol 1999;161:188–192.PubMedCrossRefGoogle Scholar
  20. 20.
    Scardino PT, Kim ED. Rationale for and results of nerve grafting during radical prostatectomy. Urology 2001;57:1016–1019.PubMedCrossRefGoogle Scholar
  21. 21.
    Kim ED, Nath R, Slawin KM, et al. Bilateral nerve grafting during radical retropubic prostatectomy: extended follow-up. Urology 2001;58:983–987.PubMedCrossRefGoogle Scholar
  22. 22.
    Kim ED, Scardino PT, Kadmon D, et al. Interposition sural nerve grafting during radical retropubic prostatectomy. Urology 2001;57:211–216.PubMedCrossRefGoogle Scholar
  23. 23.
    Porpiglia F, Ragni F, Terrone C, et al. Is laparoscopic unilateral sural nerve grafting during laparoscopic radical prostatectomy effective in retaining sexual potency? BJU Int 2005;95:1267–1271.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaouk JH, Desai MM, Abreu SC, et al. Robotic assisted laparoscopic sural nerve grafting during radical prostatectomy: initial experience. J Urol 2003;170:909–912.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith JA Jr, Herrell SD. Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages? J Clin Oncol 2005;23(32):8170–8175.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2007

Authors and Affiliations

  • Can Öbek
    • 1
  • Ali Rýza Kural
    • 2
  1. 1.Department of UrologyYeditepe University HospitalIstanbulTurkey
  2. 2.Department of UrologyUniversity of Istanbul Cerrahpasa School of MedicineBeslktasTurkey

Personalised recommendations