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• W44088029 abstract "No AccessJournal of Urology1 Oct 1987Potency Following Radical Prostatectomy with Wide Unilateral Excision of the Neurovascular Bundle Patrick C. Walsh, Jonathan I. Epstein, and Franklin C. Lowe Patrick C. WalshPatrick C. Walsh More articles by this author , Jonathan I. EpsteinJonathan I. Epstein More articles by this author , and Franklin C. LoweFranklin C. Lowe More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)43385-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Delineation of the neurovascular bundles has made it possible to identify the branches of the pelvic plexus to the corpora cavernosa intraoperatively and to decide whether the bundles can be preserved or resected widely with the specimen. In the course of performing 312 radical retropubic prostatectomies the neurovascular bundle was widely excised unilaterally in 49 men with advanced clinical disease in whom, based on preoperative or intraoperative assessment, the bundle appeared to be involved by tumor. Because of this selection criterion these patients had higher clinical stage (52 per cent had clinical stage B2) and pathological stage (35 per cent had microscopic involvement of pelvic lymph nodes) disease than our previously reported series. In 38 patients the margins of resection were negative for tumor. In 11 patients despite attempts at wide excision of the lesion the surgical margins of resection were positive. In all 11 men with positive surgical margins there was extensive periprostatic extension of tumor and 8 had involvement of the pelvic lymph nodes. However, in none of the 11 patients with positive surgical margins were the margins positive only at the site where the bundle was spared, which shows that unilateral sparing of the neurovascular bundle did not compromise removal of tumor. Of the 29 men who were potent preoperatively and who have been followed for 1 year or longer postoperatively 20 (69 per cent) are potent. The return of sexual function correlated with age: 5 of 5 men (100 per cent) 40 to 49 years old were potent postoperatively compared to 8 of 10 (80 per cent) 50 to 59 years old and 7 of 14 (50 per cent) 60 to 69 years old. Histological evaluation of the resected specimens revealed that some of the men who were potent postoperatively had soft tissue and nerves resected in the region of the contralateral spared neurovascular bundle. By measuring nerves in the spared region of the neurovascular bundle we found that the role of the neurovascular bundles in potency is not owing to large nerves but to many nerves of varying size. In conclusion, potency can be maintained after radical prostatectomy in most patients in whom it is necessary to excise 1 neurovascular bundle widely without compromising the removal of tumor. © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByHAN M, PARTIN A, CHAN D and WALSH P (2018) An Evaluation of the Decreasing Incidence of Positive Surgical Margins in a Large Retropubic Prostatectomy SeriesJournal of Urology, VOL. 171, NO. 1, (23-26), Online publication date: 1-Jan-2004.KIM E, NATH R, KADMON D, LIPSHULTZ L, MILES B, SLAWIN K, TANG H, WHEELER T and SCARDINO P (2018) BILATERAL NERVE GRAFT DURING RADICAL RETROPUBIC PROSTATECTOMY: 1-YEAR FOLLOWUPJournal of Urology, VOL. 165, NO. 6 Part 1, (1950-1956), Online publication date: 1-Jun-2001.FENG M, HUANG S, KAPTEIN J, KASWICK J and ABOSEIF S (2018) EFFECT OF SILDENAFIL CITRATE ON POST-RADICAL PROSTATECTOMY ERECTILE DYSFUNCTIONJournal of Urology, VOL. 164, NO. 6, (1935-1938), Online publication date: 1-Dec-2000.WALSH P (2018) RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER PROVIDES DURABLE CANCER CONTROL WITH EXCELLENT QUALITY OF LIFE: A STRUCTURED DEBATEJournal of Urology, VOL. 163, NO. 6, (1802-1807), Online publication date: 1-Jun-2000.KAO T, CRUESS D, GARNER D, FOLEY J, SEAY T, FRIEDRICHS P, THRASHER J, MOONEYHAN R, McLEOD D and MOUL J (2018) MULTICENTER PATIENT SELF-REPORTING QUESTIONNAIRE ON IMPOTENCE, INCONTINENCE AND STRICTURE AFTER RADICAL PROSTATECTOMYJournal of Urology, VOL. 163, NO. 3, (858-864), Online publication date: 1-Mar-2000.KIM E, SCARDINO P, HAMPEL O, MILLS N, WHEELER T and NATH R (2018) INTERPOSITION OF SURAL NERVE RESTORES FUNCTION OF CAVERNOUS NERVES RESECTED DURING RADICAL PROSTATECTOMYJournal of Urology, VOL. 161, NO. 1, (188-192), Online publication date: 1-Jan-1999.Lowentritt B, Scardino P, Miles B, Orejuela F, Schatte E, Slawin K, Elliott S and Kim E (2018) SILDENAFIL CITRATE AFTER RADICAL RETROPUBIC PROSTATECTOMYJournal of Urology, VOL. 162, NO. 5, (1614-1617), Online publication date: 1-Nov-1999.CANGIANO T, LITWIN M, NAITOH J, DOREY F and deKERNION J (2018) INTRAOPERATIVE FROZEN SECTION MONITORING OR NERVE SPARING RADICAL RETROPUBIC PROSTATECTOMYJournal of Urology, VOL. 162, NO. 3 Part 1, (655-658), Online publication date: 1-Sep-1999.JUNG G, SPENCER E and LUE T (2018) GROWTH HORMONE ENHANCES REGENERATION OF NITRIC OXIDE SYNTHASE-CONTAINING PENILE NERVES AFTER CAVERNOUS NERVE NEUROTOMY IN RATSJournal of Urology, VOL. 160, NO. 5, (1899-1904), Online publication date: 1-Nov-1998.Lim A, Brandon A, Fiedler J, Brickman A, Boyer C, Raub W and Soloway M (2018) Quality of Life: Radical Prostatectomy Versus Radiation Therapy for Prostate CancerJournal of Urology, VOL. 154, NO. 4, (1420-1425), Online publication date: 1-Oct-1995.Carrier S, Zvara P, Nunes L, Kour N, Rehman J and Lue T (2018) Regeneration of Nitric Oxide Synthase-Containing Nerves After Cavernous Nerve Neurotomy in the RatJournal of Urology, VOL. 153, NO. 5, (1722-1727), Online publication date: 1-May-1995.Geary E, Dendinger T, Freiha F and Stamey T (2018) Nerve Sparing Radical Prostatectomy: A Different ViewJournal of Urology, VOL. 154, NO. 1, (145-149), Online publication date: 1-Jul-1995.Walsh P, Partin A and Epstein J (2018) Cancer Control and Quality of Life Following Anatomical Radical Retropubic Prostatectomy: Results at 10 YearsJournal of Urology, VOL. 152, NO. 5 Part 2, (1831-1836), Online publication date: 1-Nov-1994.van den Ouden D, Davidson P, Hop W and Schröder F (2018) Radical Prostatectomy as a Monotherapy for Locally Advanced (Stage T3) Prostate CancerJournal of Urology, VOL. 151, NO. 3, (646-651), Online publication date: 1-Mar-1994.Epstein J, Carmichael M, Pizovt G and Walsh P (2018) Influence of Capsular Penetration on Progression Following Radical Prostatectomy: A Study of 196 Cases with Long-Term FollowupJournal of Urology, VOL. 150, NO. 1, (135-141), Online publication date: 1-Jul-1993.Partin A, Borland R, Epstein J and Brendler C (2018) Influence of Wide Excision of the Neurovascular Bundle(s) on Prognosis in Men with Clinically Localized Prostate Cancer with Established Capsular PenetrationJournal of Urology, VOL. 150, NO. 1, (142-146), Online publication date: 1-Jul-1993.Olsson C (2018) Editorial CommentsJournal of Urology, VOL. 150, NO. 1, (146-147), Online publication date: 1-Jul-1993.Djamilian M, Stief C, Hartmann U and Jonas U (2018) Predictive Value of Real-Time Rigiscan Monitoring for the Etiology of Organogenic ImpotenceJournal of Urology, VOL. 149, NO. 5 Part 2, (1269-1271), Online publication date: 1-May-1993.Daniels G, Mcneal J and Stamey T (2018) Predictive Value of Contralateral Biopsies in Unilaterally Palpable Prostate CancerJournal of Urology, VOL. 147, NO. 3 Part 2, (870-874), Online publication date: 1-Mar-1992.Burgers J, Nelson R, Quinlan D and Walsh P (2018) Nerve Growth Factor, Nerve Grafts and Amniotic Membrane Grafts Restore Erectile Function in RatsJournal of Urology, VOL. 146, NO. 2 Part 1, (463-468), Online publication date: 1-Aug-1991.Steiner M, Morton R and Walsh P (2018) Impact of Anatomical Radical Prostatectomy on Urinary ContinenceJournal of Urology, VOL. 145, NO. 3, (512-514), Online publication date: 1-Mar-1991.Wein A (2018) Editorial CommentsJournal of Urology, VOL. 145, NO. 3, (514-515), Online publication date: 1-Mar-1991.Quinlan D, Epstein J, Carter B and Walsh P (2018) Sexual Function following Radical Prostatectomy: Influence of Preservation of Neurovascular BundlesJournal of Urology, VOL. 145, NO. 5, (998-1002), Online publication date: 1-May-1991.Morton R, Steiner M and Walsh P (2018) Cancer Control following Anatomical Radical Prostatectomy: An Interim ReportJournal of Urology, VOL. 145, NO. 6, (1197-1200), Online publication date: 1-Jun-1991.Catalona W and Bigg S (2018) Nerve-Sparing Radical Prostatectomy: Evaluation of Results after 250 PatientsJournal of Urology, VOL. 143, NO. 3, (538-543), Online publication date: 1-Mar-1990. (2018) Reply by AuthorJournal of Urology, VOL. 141, NO. 4, (962-962), Online publication date: 1-Apr-1989.Walsh P (2018) Editorial CommentJournal of Urology, VOL. 139, NO. 6, (1240-1241), Online publication date: 1-Jun-1988.Walsh P (2018) Editorial CommentsJournal of Urology, VOL. 140, NO. 6, (1403-1403), Online publication date: 1-Dec-1988.Schlegel P and Walsh P (2018) Neuroanatomical Approach to Radical Cystoprostatectomy with Preservation of Sexual FunctionJournal of Urology, VOL. 138, NO. 6, (1402-1406), Online publication date: 1-Dec-1987. Volume 138Issue 4 Part 1October 1987Page: 823-827 Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick C. Walsh More articles by this author Jonathan I. Epstein More articles by this author Franklin C. Lowe More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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