REVIEW  PROSTATE CANCER 

Minerva Chirurgica 2019 February;74(1):28-36

DOI: 10.23736/S0026-4733.18.07848-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Neuro-anatomic basis of potency recovery after radical prostatectomy: an expert’s point of view

Clément C. ABBOU ¹ ✉, Ahmed ABDELBARY ²

¹ Department of Urology, Henri Mondor Hospital, Créteil, France; ² Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

INTRODUCTION: From 25% to 95% of those who have undergone radical prostatectomy (RP) report erectile dysfunction 12 months after surgery. We attempt a review of the available evidence regarding the anatomy of the cavernous nerves and the surgical refinements to enhance sexual function recovery after surgery.
EVIDENCE ACQUISITION: The PubMed/Medline database was searched. Duplicates were removed. Studies were selected by the authors according to the aim of the present review.
EVIDENCE SYNTHESIS: The cavernous nerves are deemed responsible for erections, but their exact function is still a matter of debate. They do not necessarily have the same distribution in all individuals: in most the cases, these nerves are located posterolaterally, however, it is not uncommon to find some fibers on the anterolateral aspects of the prostate, especially towards the apex. Several technical strategies were proposed in order to intraoperatively identify and spare the neurovascular bundles: despite all efforts, clinical results are still only partially satisfying.
CONCLUSIONS: The recovery of potency is one of the most unpredictable outcomes after RP. The advent of the robotic surgical system seems to have brought a trend towards a faster recovery of erectile function.

KEY WORDS: Penile erection - Erectile dysfunction - Prostatectomy - Hypogastric plexus