Evaluation of Surgical and Function Outcomes after Bilateral Intravesical Nerve-Sparing Laparoscopic Radical Prostatectomy after TUR-P for Incidental Prostate Cancer

Research Article

Austin J Urol. 2016; 3(1): 1037.

Evaluation of Surgical and Function Outcomes after Bilateral Intravesical Nerve-Sparing Laparoscopic Radical Prostatectomy after TUR-P for Incidental Prostate Cancer

Greco F1,2*, Altieri V1 and Mirone V²

¹Department of Urology and Centre of Mini-Invasive Surgery, Romolo Hospital, Italy

²Department of Urology, Federico II University, Italy

*Corresponding author: Francesco Greco, Department of Urology and Centre of Mini-Invasive Surgery, Romolo Hospital, Rocca di Neto, Italy

Received: August 21, 2015; Accepted: December 28, 2015; Published: January 05, 2016


Objective: To evaluate the impact of nerve-sparing laparoscopic radical prostatectomy (nsLRPT) on surgical and functional outcomes, by using validated questionnaire in patients affected by incidental prostate cancer.

Materials and Methods: Retrospective single surgeon study including 125 consecutive patients who underwent a nsLRP for incidental prostate cancer diagnosed after TUR-P. International Index of Erectile Function (IEEF5) was administered preoperatively, and at 3, 6 and 12 months postoperatively. Potency was defined as a score >17 points. Clinical data were also recorded at each time point.

Results: The mean operative time was 153.1±35.4 min with a mean intraoperative blood loss of 350.3±150.4 ml and a transfusion rate of 1.6%. The mean catheterization time was 8±1 days and the mean length of hospitalization results to be shorter after nsLRPT was 7.2±2.1 days. No major complications occurred in both groups.

Positive margins were detected in only 1 patient (1.8%) with a pT2c tumour. Nevertheless, at a median follow-up of 48 months, all patients were alive with no evidence of tumour recurrence. At the 12th months, a complete continence was reported in 98.4% of patients who underwent surgery. Regarding sexual potency, 52% and 78.4% of all patients reported the ability to engage in sexual intercourse at 6- and 12- months after surgery, respectively.

Conclusion: NsLRP after TUR-P, performed by expert surgeons, results to be a safe procedure with excellent functional outcomes with regard to the urinary continence and sexual potency.

Keywords: Bilateral intrafascial nerve-sparing radical prostatectomy; Incidental prostate cancer; Laparoscopy; Transurethral prostate resection; Sexual function; Outcomes


Currently, Radical Prostatectomy (RP) is the only treatment for localised prostate cancer that has shown a cancer-specific survival benefit when compared with conservative management [1].

In the last decade, laparoscopic radical prostatectomy has been increasingly used for the surgical treatment of prostate cancer and it is now considered a well-established alternative to open surgery [2].

Incidental cancer of the prostate is found in 3%-16% of Transurethral Resection of the Prostate (TURP) specimens [3].

It has been reported that nerve-sparing Radical Prostatectomy (nsRP) after previous prostate surgery can be challenging [3-6]. In literature there is only one report regarding the nerve-sparing open Radical Prostatectomy (nsRRPT) in patients previously subjected to prostatic surgery for Benign Prostate Hyperplasia (BPH) [7] but few studies regarding the laparoscopic bilateral nerve-sparing radical prostatectomy after TUR-P are actually available.

Many studies on Erectile Dysfunction (ED) following nervesparing RRP have been published, revealing widely disparate potency rates (30-86%) among various groups in different studies [8]. This variation in potency rates may be due to patient selection, surgeon and hospital volume, and the proportion of nerve-sparing procedures.

The aim of our study was to investigate the effect of nsLRPT on the surgical and functional outcomes in patients previously with incidental prostate cancer.

Materials and Methods

This was a retrospective, single-surgeon study including 125 patients who underwent an extra peritoneal Laparoscopic bilateral nerve-sparing Radical Prostatectomies (nsLRPT) for incidental prostate cancer diagnosed after TUR-P after TUR-P. All patients were informed about the procedures and written consent was obtained. Our surgical technique was previously described [2].

Shortly, after dissection of the bladder neck, the peri- prostatic fascia including the neurovascular bundles is mobilized and dissection is performed posteriorly behind the bladder neck, and the seminal vesicles and the ductus deferens are identified and dissected.

The Denonvilliers’ fascia was stripped from the prostatic capsule, and the prostatic pedicles were clipped and dissected (Figure 1A & 1B). No coagulation or ultrasound dissector was used during this step. Inclusion criteria were as follows: PSA < 10, Gleason = 7 and only two positive of at least 12 biopsy cores.