PL 13. Nerve - sparing laparoscopic radical prostatectomy (100 cases report)
This study aimed to evaluate the effect of reservation of nervesparing laparoscopic radical prostatectomy (NSLRP) on the postoperative quality.
Between February 2001 and July 2010, we performed LRP on 426 patients with localized prostate cancer (Pca). Of them, 100 patients with preoperative erectile function (IIEF5 scores range from 16 to 24) and indications (PSA<10 ng/mL; Gleason scores<7; Age<70 years old) underwent NSLRP. Among them, 69 cases had bilateral NSLRP, and 31 cases had unilateral NSLRP. The main techniques of NSLRP was duplicated the Walsh's technique in open surgery. Briefly, the key step of the technique including: opened the Denonvillier's fascia and dissected posterior wall of prostate; raise the bilateral seminal vesicles and expose the bilateral ligaments of prostate; prostate pedicle was dissected outside of the base of seminal vesicle and cut off close to the prostate with hemo-lock or ultrasound knife. Then opened pelvic levator ani fascia longitudinally from the lateral of the prostate lateral, the lateral prostate ligament was dissected longitudinally above the neurovascular bundles using ultrasound knife, or ligated with Hemo-lock discontinously and then cut off in the same way. Dissociate the urethra at the apex of prostate and avoid the damage of cavervnous nerves which go into the urethra on 5 and 7 o'clock. After surgery, continually low dose of PDE5 inhibitor therapy, intracavernous injection or vacuum constriction devices were performed for 3 months to restore the function of penis at the early stage. The patients' erectile function and urinary control were evaluated one year after the surgery.
About 67% patients who had NSLRP preserved sexual function 1 year after the surgery, in which 48% (48/100)patients make intercourse with the assist of PDE5 inhibitor, IIEF5 scores 0-7 in 21% (21/100), 8-11 in 31% (31/100), 13-21 in 42% (42/100), 22-25 in 6% (6/100), respectively. Urinary control rate at 6 and 12 months after the surgery were 93% and 99%, respectively.
The NSLRP could effectively preserve the most of the patients' sexual function, enhance the early recovery of erectile function and urinary continence. After the surgery, using low dose of PDE5 inhibitor at early stage could benefit the early recovery of erectile function.
