AB101. Nerve-sparing laparoscopic radical prostatectomy (report on 186 cases)

Introduction and objective: To evaluate the effect of nerve-sparing laparoscopic radical prostatectomy (NSLRP) on the postoperative quality of life.

Materials and methods: Between February 2001 and July 2014, we performed LRP on 852 patients with localized prostate cancer (PCa). Of them, 186 patients with preoperative erectile function (IIEF5 scores range from 14 to 26 and indications (PSA <10 ng/mL; Gleason scores <7; age<65 years old) underwent NSLRP. Among them, 116 cases had bilateral NSLRP, and 70 cases had unilateral NSLRP; of them, 42 cases were underwent single-port transvesical laparoscopic radical prostatectomy (STLRP), which first transvesical dissect the bladder neck and can mostly preserve bilateral cavernosal nerve in the most. Briefly, the key steps of the techniques following: opened the Denonvillier’s fascia and dissected posterior wall of prostate; raised the bilateral seminal vesicles and exposed the bilateral pedicle of prostate; prostate pedicle was dissected outside the base of seminal vesicle and cut off with scissors close to the prostate capsular with hemo-lock. 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 hemo-lock and scissor until to the apex of prostate. Dissociated the urethra at the apex of prostate and avoided the damage of cavernous nerves which go into the urethra from 4 to 8 o’clock. In the case of STLRP, after surgery, continually low dose of PDE5 (25 mg/d) inhibitor therapy, intracavernous injection or vacuum constriction devices was performed postoperatively one month later to restore the function of penis at the early stage. The patients’ erectile function and urinary control were evaluate done year after the surgery.

Results: About 65% patients who had NSLRP preserved sexual function 1 year after the surgery, in which 52% (97/186) of patients engage in intercourse with the assistance of PDE5 inhibitor, IIEF5 scores 0-7 in 16% (31/186), 8-11 in 29% (54/186), 13-21 in 47%(89/186), 22-25 in 6% (12/186), respectively. Urinary control rate at 6 and 12 months after the surgery were 90.5% and 96.4%, respectively. However, the IIEF in STLRP, were especially higher than other group, 75% of patients (31/42) potent with IIEF >18.

Conclusions: The NSLRP, especially with STLRP approach, could effectively preserve the most of the patients’ sexual function and improve the recovery of sexual function and urinary continence. In addition, postoperative rehabilitation of penile potent at early stage could benefit the recovery the patients’ erectile function.

Keywords: Prostate cancer (PCa); laparoscopic radical prostatectomy; single-port; erectile function