When can erectile nerves be preserved during robotic prostatectomy?
Before discovering the signs of complications, find out what symptoms to look out for in our guide:: What are the symptoms of prostate cancer?
Robotic-assisted radical prostatectomy is a commonly performed surgical procedure for the treatment of localized prostate cancer. However, this procedure can have an impact on quality of life, particularly on erectile function. Erectile nerve preservation, also known as nerve conservation, is a technique that can reduce these side effects, but is not always possible. Here’s a comprehensive guide to when this approach might be considered.
Contents
What is nerve preservation?
The erectile nerves are located in neurovascular bundles that run along each side of the pprostate. They are not visible to the naked eye.
During a prostatectomy, the surgeon may attempt to preserve them, provided this does not compromise the removal of the cancer. This is a delicate technique, as the bundles are very close to the prostate and sometimes in direct contact with the cancer cells.
Criteria for nerve preservation
Tumor location and extension
Tumor location is a key factor. If the tumor is located at a distance from the neurovascular bundles, it is possible to preserve them. However, if the tumor is close to or invades these areas, complete nerve preservation may increase the risk of cancer recurrence.
How does the surgeon assess this location?
Pre-operative imaging, such as multiparametric MRI, enables visualization of the tumor and its relationship with the neurovascular bundles. This assessment is essential for deciding on the surgical strategy.
Gleason score and cancer aggressiveness
What is the Gleason score?
The Gleason score is a scale that measures the aggressiveness of cancer cells. The higher the score, the more aggressive the cancer. For example, a score of 6 indicates a less aggressive cancer, while a score of 8 or more suggests an advanced cancer.
Impact on nerve preservation
For less aggressive cancers (score 6 or 7), nerve preservation is often possible. For higher scores, on the other hand, the chances diminish, as the priority is to completely eliminate the cancer.
Advanced techniques
Robotic-assisted techniques enable 3D visualization and precise movements, improving the chances of nerve preservation. The use of appropriate energies, such as bipolar forceps, also reduces collateral damage.
Patient factors
Age and general health
Younger (under 65), healthier patients are more likely to recover erectile function after surgery. Co-morbidities, such as diabetes or cardiovascular disease, can also influence recovery.
Importance of preoperative discussion
An open discussion between patient and surgeon is essential. The patient’s expectations in terms of sexual quality of life and cancer treatment priorities must be taken into account to define an appropriate strategy.
This makes it possible to stratify priorities, taking into account the disease, its stage, the patient’s history and, above all, his or her expectations.
Conclusion
Preservation of erectile nerves during prostatectomy for cancer is an important objective for improving patients’ quality of life. However, it is not always possible, and depends on many factors, including the location and aggressiveness of the cancer. Accurate assessment and personalized discussion help optimize the outcome for each patient.
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