Advanced Nerve Sparing Radical Retropubic Prostatectomy at Fortis Hospital Bangalore

The perils of prostate cancer are well-known. In America, men are diagnosed with this deadly form of cancer once every 3 minutes. The presence of prostate cancer can be diagnosed with the aid of symptoms showcased by the patient, a physical examination by a doctor, along with diagnostic tools such as digital rectal examination (DRE), prostate-specific antigen (PSAtrans-rectal ultrasound (TRUS), and pelvic Nuclear Magnetic Resonance Imaging (MRI) examination.

The question that arises then is whether to opt for the best form of treatment which can not only get rid of the tumours but also ensure that sexual function doesn’t get compromised. Today, there’s no dearth of options available for the patient. One such option is the revolutionary nerve-sparing radical retropubic prostatectomy

Nerve-sparing Radical Retropubic Prostatectomy

Open radical prostatectomy techniques have gone through an evolution in recent years. For a long time, radical prostatectomy was recognized and considered as an effective cure for clinically localized prostate cancer and usually recommended for patients who have been diagnosed with a low–intermediate risk of disease and a life expectancy of more than 10 years. That said, the primary concern with a radical prostatectomy operation was that it was associated with being linked with postoperative morbidities leading to sexual function often getting lost. Accordingly, erectile dysfunction and urinary incontinence was a common occurrence and one of the most dreaded adverse effects post-surgery.

However, nerve-sparing radical retropubic prostatectomy tends to address that by preserving anatomic structures so as to minimize the impact on outcome and quality of the patient’s life. In that regard, it also helps in enhancing or boosting the potential for recovery of continence and potency in a patient.

The objective of this surgical technique is to ensure that the cavernous nerves of the penis – responsible for controlling the erection – are safeguarded as they’re responsible for controlling the erection. However, owing to the fragile nature of these nerves, they can be easily damaged which can adversely affect the man’s ability to sustain or even get an erection. This is because, at times, the underlying cancer can easily get tangled with the nerves which, in turn, may affect the nerve function. Which is why these nerves might need to get cut in order to ensure that the cancerous tissues are fully removed. But in case both sides of the nerves are taken out, it might severely hinder the man's ability to get an erection which won't improve over time either.

In the event where only one side of the nerves is removed, there's an increased likelihood of some sexual function still remaining. In case the nerves are left untouched during the procedure, there might not be an adverse effect on the functioning at all. That said, it might take a long time for the patient to understand if he's going to fully recover as the sexual function might take a long time to get restored to normalcy. Fact is there are several other factors which need to be accounted for as well. The skill, experience and finesse of the surgeon also play a vital role in determining whether the entirety of the sexual function can be restored. Moreover, in the case of men under the age of 60, the odds of them recovering full function – especially if the nerves have been left undamaged on both sides of the gland – are very high.

Because of the nature of the surgery and benefits of keeping the nerves untouched, more and more surgeons are increasingly using the nerve-sparing radical retropubic prostatectomy method with the ultimate hope of preserving erectile function post-surgery.

Furthermore, there’s more good news to rejoice as various studies have revealed that men who opt for nerve-sparing surgery haven’t noticed any rise in the risk of positive margins or biochemical recurrence (i.e., increasing PSA) within a time span of 5 years of surgery – even in cases where the surgery had been performed in patients displaying critical prognostic factors.

Last but not least, it has been observed that there has not been an increase in the risk in patients who have undergone nerve-sparing surgeries for leaving tumour cells behind upon removal of the prostate.