Nerve-sparing quality boosts urinary recovery after radical prostatectomy

The quality of nerve sparing during radical prostatectomy has a significant influence on the recovery of urinary function in men with prostate cancer, research shows.

Christian Pavlovich (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) and colleagues found that men who had excellent nerve sparing of one or both neurovascular bundles had better urinary function than men who did not within 1 month of surgery. And, this statistically significant difference was maintained over a year’s follow-up.

“These data suggest that, at least among potent men in whom [nerve sparing] is oncologically justifiable, judicious attempts to completely spare at least 1 neurovascular bundle and its overlying periprostatic tissues might pay dividends in terms of functional urinary convalescence,” the team writes in Urology.

They studied 102 men with prostate cancer with normal erectile function who underwent laparoscopic or robotic minimally invasive, nerve-sparing radical prostatectomy at a single institution. The surgeons subjectively classified nerve-sparing quality on each side during surgery.

Overall, 45 patients had both neurovascular bundles spared excellently; 30 had only one neurovascular bundle spared excellently; and 24 had standard nerve sparing where at least one bundle was spared but neither spared excellently. Three patients did not undergo any nerve sparing and were excluded from analyses.

The researchers found that in all patients, measures of urinary function according to the Expanded Prostate Cancer Index Composite (EPIC) questionnaire fell immediately following surgery. However, 1-month postoperatively, patients with excellent nerve sparing of one or both bundles had significantly higher scores on the Urinary Domain Summary Score (USS), Urinary Incontinence Subscale (UIN), and Urinary Function Subscale (UFS).

And by 9 months postoperatively, patients who had one or both neurovascular bundles excellently spared had significantly higher scores on all subscales of the EPIC questionnaire apart from the Urinary Irritative/Obstructive Subscale (UIR); these differences were maintained at 12 months.

In multivariate analysis, excellent sparing of at least one neurovascular bundle was significantly associated with improvements in all EPIC urinary domains, except UIR, in the 12 months following surgery. Additionally, increasing body mass index predicted poorer USS, UIN, and UFS scores, while increasing age was associated with greater pad usage.

Pavlovich and colleagues say that, as urinary outcomes were similar between patients with bilateral and unilateral excellent nerve sparing in their study, sparing at least one neurovascular bundle “as meticulously as possible” could improve postoperative outcomes, as well as allow for more extensive resection on the other side without compromising urinary function recovery.

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