What is nerve-sparing prostatectomy?

Marc B. Garnick, MD
Hematology & Oncology
Men have traditionally shuddered at the risks of radical prostatectomy, especially permanent impotence, which used to occur in nearly all cases. But that began to change in the early 1980s, when a so-called nerve-sparing operation was developed. During this surgery, doctors attempt to spare the two bundles of nerves that lie on either side of the prostate gland and control erections. This type of operation may also reduce the likelihood of other serious side effects, such as urinary incontinence and significant blood loss.
There are nerves and blood vessels that course right against the prostate at the 5 and 7 o'clock positions of the prostate. These function to aid with erectile function and continence. During removal of the prostate, the surgeon can dissect these away from the prostate so they can remain intact and functional. They often may have to heal after the surgery given that there is inflammation that occurs during the healing process. During this time, they do not function as well, which is one of the reasons men may have ED and urinary incontinence after prostate removal. Some men with larger amounts of prostate cancer or more aggressive forms may not be candidates for nerve-sparing due to the risk for leaving cancer cells behind. This needs to be discussed on patient-specific basis. 
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