Several studies have demonstrated that younger patients have a greater chance of retaining their potency after radical prostatectomy.2'11'16'20'21 Younger patients typically have smaller tumor burdens, are more sexually active preoperatively and, therefore, are more likely to undergo a nerve-sparing procedure.16 One study demonstrated that men younger than 70 years old who had a bilateral nerve-sparing procedure had a threefold increase in their odds of retaining their potency.20 Preserving potency revolves around sparing the nerves of varing sizes that comprise the neurovascular bundle, not just the large nerves in the area.15
The pathological stage of the tumor also plays a role in predicting postoperative potency. Eggleston and Walsh found that with more advanced disease the potency rate decreased because, with extraprostatic extension of tumor, the neurovas-cular bundles had to be more widely excised.14 Quinlan etal. reported that the relative risk of impotence increased by a factor of two, if the tumor had invaded through the prostatic capsule or the seminal vesicles.2 The pathological stage dictates what type of nerve-sparing procedure can be performed. Prostate cancer that extends through the capsule produces a desmoplastic response, which can be seen intraopera-tively.14'15'22'23 The surgeon can then decide at that time whether to sacrifice the neurovascular bundles. Thus sacrificing the neurovascular bundles secondary to the fibrosis seen during the procedure would ultimately increase the rate of impotence as discussed above.
Was this article helpful?