[Nerve-sparing open radical prostatectomy with extracapsular dissection].

BACKGROUND: Potency recovery after radical prostatectomy (RP) has to be weighed against the risks of nerve-sparing surgery in relation to long-term cancer control. OBJECTIVE: To apply quality control criteria for RP, define the risk of iatrogenic positive margins and evaluate nerve-sparing dissection and sexual outcomes. INTERVENTION: Nerve-sparing retropubic RP with "extracapsular" dissection. METHOD: Histopathology : whole-mount 3-mm serial sections from the prostate apex to base using the Stanford technique. Recovery of erectile function evaluated with the abridged version of the International Index for Erectile Function (IIEF-5). RESULTS: Prospective study about 507 consecutive RP candidates. Bilateral nerve-sparing (n=273, 88.1%), unilateral (n=37, 11.9%). The risk of iatrogenic positive margins was 5%. The positive surgical margin rate was 6.3% (2.2% for pT2 and 14.5% for pT3). The potency recovery rate with or without type 5 phosphodiesterase inhibitor assistance was 83.5% at 1 year and 95.1% at 2 years. CONCLUSION: Nerve-sparing can be performed in a dissection plane outside the boundaries of the capsule, thus ensuring oncological safety whilst providing highly satisfactory potency recovery rates.