Abstract
Nerve-sparing radical prostatectomy is the therapy of choice in selected prostate
cancer patients. In an internal quality control including a questionnaire, our nerve-sparing
radical prostatectomies have been analysed for oncological and functional results
as well as patient satisfaction. 171 consecutive nerve sparing radical prostatectomies
have been analysed, 123 bilateral, 48 unilateral. The median follow-up was 26 (2–56)
months. The operations were performed by 5 surgeons. In 27 % the T-category and in
12 % the Gleason score had been understaged preoperatively, 9 % had positive margins
and in 4 % lymph nodes were positive. 99 % of the patients stated that they would
again prefer the operation as treatment of first choice. 95 % were satisfied with
their postoperative situation. 53 % of the patients had erections sufficient for sexual
intercourse following the bilateral, 25 % following the unilateral nerve-sparing procedure.
The time until recurrence of erections was 1 month in 42 %, 6 months in 90 % and 12 months
in 100 % of the potent men. 90 % of all patients within the observation period are
fully continent, 10 % of the patients need more than 1 pad. The intersurgeon variability
is 77–98 % for continence and 25–60 % for potency. Patient satisfaction, oncological
and functional results are good. The understaging rate suggests the necessity for
better patient selection including re-biopsy and reference histology. 27 % would
have been undertreated by brachytherapy as alternative treatment. Intensive surgeon
teaching is mandatory.
Key words
nerve-sparing radical prostatectomy - patient satisfaction - potency - continence
- influence of surgeon
References
t.kaelble.urologie@klinikum-fulda.de
