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What Is Nerve-Sparing Surgery?

By Glyn Sinclair
Updated May 17, 2024
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Nerve-sparing surgery is a surgical technique that attempts to spare the nerves around the area that is being operated on. This technique is often applied during radical retropubic prostatectomy, which is a surgery for prostate cancer. Surgeons will try to save the nerves around the prostate gland if they do not appear to be cancerous. Loss of erection can be a result of nerve damage around the prostate gland. Nerve-sparing surgery requires a highly skilled surgeon for a successful outcome.

Surgeons performing radical prostatectomy will try to find the penis’s cavernous nerves visually before performing nerve-sparing surgery. They can also identify them by applying an electrical stimulation test. There are two approaches to this surgery, the bilateral approach and the unilateral approach. The bilateral approach attempts to save nerve bundles on either side of the prostate and the unilateral method attempts to save nerves just on one side. This latter approach is typically used when the cancer has already spread to the nerves on one side of the prostate.

If nerves on both sides of the prostate appear to be cancer free, the surgeon will often leave them in place. Even if the nerves are untouched, they can sometimes get stretched or traumatized during surgery and suturing. It can sometimes take between three to 15 months for men to experience erectile function again, although they are still able to have erections even if just one nerve bundle remains. Surgical centers and doctors performing high volumes of this surgery tend to have increased potency rates for men.

Many times, if the cancer seems to be widespread, a surgeon will opt to perform non-nerve-sparing surgery. This is when a large area is excised around the prostate, including the nerve bundles. If the surgeon is unable to spare the nerves, he will sometimes replace the original nerves with nerve-grafts from the foot. Even with these techniques, it does not fully ensure that potency will return. The rates do seem to be higher with younger men, and decrease with those who are older and suffer from diabetes or high blood pressure.

Drugs like Viagra® are helpful to those experiencing erectile dysfunction after nerve-sparing surgery; however, penal implants may be a last resort. Other post surgical problems include incontinence, or loss of urine control, but this is usually temporary and mild in degree. There are other therapeutic options such as physical therapy that can help when patients experience these particular problems.

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