Nerve-Sparing Robotic Prostatectomy
Preserving the Nerves During Robotic Prostate Cancer Surgery
Nerve-sparing robotic prostatectomy is a surgical approach used for selected patients undergoing radical prostatectomy for prostate cancer. Where it is considered safe and appropriate, the aim is to remove the prostate and treat the cancer while preserving the nerves that are important for erectile function.
These delicate nerves run very close to the prostate, which means that the possibility of preserving them depends particularly on the location and extent of the prostate cancer.
Mr Neil Oakley has extensive experience in nerve-sparing robotic radical prostatectomy and can assess whether a nerve-sparing approach may be appropriate as part of an individual consultation and review of your prostate cancer investigations.
What Does Nerve-Sparing Prostatectomy Mean?
The nerves responsible for helping produce erections run alongside the prostate within structures known as the neurovascular bundles.
During a radical prostatectomy, the prostate gland and seminal vesicles are removed. Depending on the position and extent of the cancer, it may be possible to carefully separate and preserve the neurovascular bundles rather than removing them with the prostate.
This is known as nerve-sparing radical prostatectomy.
Nerve-sparing may be possible on both sides of the prostate, on one side, or in some cases it may not be considered appropriate to preserve the nerves.
Why Are the Nerves Important?
The neurovascular bundles contain nerves involved in the process that produces an erection.
Radical prostatectomy can affect erectile function because of the very close anatomical relationship between these nerves and the prostate. Preserving the nerves where it is oncologically safe to do so is intended to give suitable patients a better opportunity for recovery of erectile function following surgery.
However, nerve-sparing surgery cannot guarantee that erections will return to their pre-operative level. Erectile function following prostatectomy is affected by a number of factors and recovery can take time.
Who May Be Suitable for Nerve-Sparing Prostatectomy?
Whether nerve-sparing surgery is appropriate needs to be considered individually.
Factors that may influence the decision include:
- The location of the prostate cancer
- The grade and stage of the cancer
- MRI findings
- Prostate biopsy results
- Whether there is concern that the cancer extends close to or beyond the prostate
- Pre-operative erectile function
- Age and general health
- The patient's individual priorities and circumstances
MRI scans and biopsy results can provide important information about where the cancer is situated within the prostate and its relationship to the prostate capsule and surrounding tissues.
Mr Oakley can review these investigations when considering whether nerve preservation may be appropriate.
Cancer Control Comes First
The primary objective of radical prostatectomy is to treat the prostate cancer effectively.
Although preserving erectile function is an important consideration, nerve preservation should not compromise the aim of removing the cancer.
If the cancer is situated very close to the neurovascular bundle, or there is concern that it extends beyond the prostate in this area, attempting to preserve the nerves may not be appropriate.
This is why nerve-sparing prostatectomy is not simply a technique that can automatically be offered to every patient undergoing robotic prostate surgery.
The balance between cancer control and preservation of function should be considered carefully using the available clinical information and discussed with the patient before surgery.
Bilateral and Unilateral Nerve-Sparing
There are neurovascular bundles on both sides of the prostate.
For some patients, it may be possible to preserve the nerves on both sides of the prostate. This is generally referred to as bilateral nerve-sparing.
For others, the characteristics or position of the cancer may mean that preservation is considered appropriate on only one side. This is referred to as unilateral nerve-sparing.
In some circumstances, the safest approach from a cancer treatment perspective may be not to preserve the neurovascular bundle on either side.
The appropriate approach depends on the individual cancer rather than following the same surgical plan for every patient.
How Does Robotic Surgery Assist Nerve-Sparing?
The prostate is located deep within the pelvis, with the neurovascular bundles running closely alongside it.
During robotic radical prostatectomy, the da Vinci robotic surgical system provides the surgeon with a magnified three-dimensional view of the operating area and highly controlled articulated instruments.
This allows detailed dissection around the prostate and surrounding structures during the operation.
The robotic system does not perform the operation independently. Mr Oakley controls the instruments throughout the procedure and makes the surgical decisions regarding dissection and nerve preservation.
Find out more about Robotic Radical Prostatectomy
Will Nerve-Sparing Preserve Erectile Function?
Nerve-sparing surgery aims to improve the possibility of erectile function recovering after radical prostatectomy, but it cannot guarantee this outcome.
Even when the nerves can be preserved, they can be temporarily affected by the operation and may take time to recover.
The likelihood and speed of recovery vary considerably between patients and can be influenced by:
- Erectile function before surgery
- Age
- General and cardiovascular health
- Whether nerve-sparing is possible on one or both sides
- The extent to which the nerves can safely be preserved
- Individual healing and recovery
Recovery of erectile function can therefore be gradual and may continue for many months following surgery.
What If Erectile Function Is Affected After Surgery?
Changes in erectile function are an important potential side effect of radical prostatectomy and should be discussed before deciding to proceed with surgery.
Where appropriate, treatments can be used to support erectile function and sexual rehabilitation following prostatectomy. These may include oral medication, vacuum erection devices and other treatments depending on the individual patient's circumstances and response.
The most appropriate approach will depend on factors including pre-operative erectile function, whether nerve preservation was possible and progress following surgery.
Other Changes to Sexual Function
Radical prostatectomy results in permanent changes to ejaculation and fertility because the prostate and seminal vesicles are removed.
Following the operation, it is no longer possible to produce semen during orgasm. This is sometimes referred to as a ‘dry orgasm’.
Natural fertility is therefore lost following radical prostatectomy. Men who may wish to have children in the future should discuss fertility and the possibility of sperm storage before undergoing treatment.
These considerations form an important part of informed decision-making before prostate cancer surgery.
Recovery After Nerve-Sparing Robotic Prostatectomy
The general recovery following nerve-sparing robotic prostatectomy is similar to recovery following other robotic radical prostatectomy procedures.
A urinary catheter is required temporarily while the connection between the bladder and urethra heals. Patients are encouraged to mobilise following surgery and gradually increase their activity as recovery progresses.
Urinary continence and erectile function recover differently in each patient and should be considered as separate aspects of rehabilitation.
Pelvic floor exercises are important for urinary continence, while appropriate erectile rehabilitation may be discussed following surgery.
Find out more about Life After Robotic Prostatectomy
Discussing Nerve-Sparing Before Surgery
If you are considering radical prostatectomy, the possibility of nerve preservation should be discussed before your operation.
Mr Oakley can review your MRI, biopsy results, PSA history and other relevant clinical information and discuss whether a nerve-sparing approach may be appropriate.
This consultation also provides an opportunity to discuss your existing urinary and sexual function, your priorities following treatment and the potential effects of prostate cancer surgery.
It is important to understand that the final surgical approach must always take account of the extent and position of the cancer, with effective cancer treatment remaining the priority.
Nerve-Sparing Robotic Prostatectomy for Sheffield Patients
Patients from Sheffield, South Yorkshire and surrounding areas who are considering robotic prostate cancer surgery can arrange a private consultation with Mr Oakley in Sheffield.
Your prostate cancer diagnosis and investigations can be reviewed locally, including consideration of whether nerve-sparing robotic prostatectomy may be appropriate.
For patients who proceed with surgery, appropriate consultation and pre-operative assessment can take place in Sheffield, with robotic radical prostatectomy performed by Mr Oakley in Manchester using the da Vinci robotic surgical system.
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Robotic Surgery for Sheffield Patients
Considering Nerve-Sparing Prostate Surgery?
If you have been diagnosed with prostate cancer and would like to discuss robotic radical prostatectomy and whether a nerve-sparing approach may be appropriate, you can arrange a private consultation with Mr Neil Oakley in Sheffield.