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 surgical procedure commonly performed to treat 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 can be considered.
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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 localization and extension
Tumor location is a key factor. If the tumor is located at a distance from the neurovascular bundles, it may be 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?
Preoperative imaging, such as multiparametric MRI, enables us to visualize the tumor and its relationship with neurovascular bundles. This assessment is essential for deciding on 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 mildly aggressive cancer, while a score of 8 or more suggests 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 eliminate the cancer completely.
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-related factors
Age and general health
Younger (under 65) and 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 the erectile nerves during prostatectomy for cancer is an important goal in improving patients’ quality of life. However, this is not always possible, and depends on many factors, including the location and aggressiveness of the cancer. Accurate assessment and personalized discussion can optimize results for every patient.
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