This study aimed to evaluate the effect of reservation of nervesparing
laparoscopic radical prostatectomy (NSLRP) on the
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.