Retrograde Nerve-Sparing (NS) Laparoscopic Radical Prostatectomy (LRP): Technical Aspects and Early Results

ObjectiveTo evaluate the early results of nerve-sparing laparoscopic radical prostatectomy (NSLRP) in our institution based on the apical approach to NS, focusing on evolution in techniques and oncologic as well as functional results.MethodsOf 1500 consecutive patients, 330 underwent bilateral NSLRP, 210 unilateral NSLRP, and 960 non-NSLRP. LRP was performed using the ascending extraperitoneal approach (Heilbronn technique). Oncologic and functional outcomes were assessed in the first 1000 patients by analysing a prospective database and using validated questionnaires for follow-up.ResultsIn the first 300 cases, 5 patients (1.6%) underwent NS compared to 143 (47.7%) in the last 300 patients. Clinical and pathologic stages of the patients were similar over this period. Forty-three men (16.3%) had positive margins compared to 53 (17.7%) when the first and last 300 cases were assessed. Prostate-specific antigen recurrence occurred in 20 (11%) in the NS versus 85 (15.7%) in the non-NS group (p = 0.076). Potency rates for bilateral NS were maximal at 61% without erectile aids versus 82.9% when all treatment modalities for erectile dysfunction were used, respectively, 34.1% versus 69.8% for unilateral, and 8.2% versus 53.3% in non-NS group (p < 0.05).ConclusionsWith increasing experience and expertise, we are performing more NS procedures during LRP despite similar clinicopathologic parameters. Improved functional outcomes such as preservation of erectile function can be achieved without oncologic compromise. All appropriate patients should be considered for the NS approach.