Nerve-sparing radical prostatectomy
Written by:
Urologist
Published: 05/03/2020
Edited by: Robert Smith
A nerve-sparing radical prostatectomy involves much more than just the removal of the prostate glands. It is an invasive procedure that needs extreme attention to detail for a successful result.
Luckily, top urologists such as Mr Neil Haldar are around in order to carry out surgeries such as this one successfully. We sat and spoke with him to discuss what is removed during a radical prostatectomy and some of the different approaches when carrying out this procedure.
Radical prostatectomy what is removed?
As well as removing the whole prostate, the surgeon will remove the seminal vesicles during a radical prostatectomy. These are two glands that are connected to the prostate and store some of the fluid in semen.
The surgeon may also remove the surrounding lymph nodes, and this is called a pelvic lymph node dissection. The reason for removing these lymph nodes is in case they contain cancer cells. It helps your surgeon to decide if further treatment is required. Taking the lymph nodes out can, in certain circumstances, reduce the risk of the cancer coming back in the future.
After carefully dissecting the prostate gland and seminal vesicles, the surgeon removes the prostate along with nearby tissue. The surgeon then has to re-attach the urethra, the tube that carries urine, to the outlet of the bladder called the bladder neck. A catheter inserted into the bladder through the penis is left in until the new join has healed to become watertight.
What is a nerve-preserving radical prostatectomy?
There are two bundles of nerves lying alongside the prostate that control erections of the penis. In a nerve-sparing radical prostatectomy, the surgeon will try to preserve these nerves. If the surgeon feels the tumour has spread out of the prostate capsule, they may remove one or both of these bundles to avoid leaving cancer cells behind. There is no evidence, however, that a nerve-sparing radical prostatectomy significantly increases the risk of the prostate cancer reoccurring so it is now considered the standard approach.
Even if the nerves are saved, it does not guarantee a return of erections which in any case can still take some months to recover. Surgeons are therefore trying to develop other approaches, such as using electrical nerve mapping during surgery or intentionally removing the nerves, then replacing them with nerve transplants. At present, these approaches are considered experimental and unproven.
Watch this great 3D animation video on the steps of prostate cancer surgery shows the laparascopic removal of a cancerous prostate gland and its surrounding tissues:
A radical prostatectomy should only be carried out by a leading professional. For more guidance on how prostate cancer should be treated or for more information on any urological related conditions, do not hesitate to get in touch with Mr Neil Haldar who will be happy to help you.