High Anterior Release of the Levator Fascia Improves Sexual Function Following Open Radical Retropubic Prostatectomy

Nielsen, Matthew E.; Schaeffer, Edward M.; Marschke, Penny; Walsh, Patrick C.

doi:10.1016/j.juro.2008.08.047

Cited by 105 publications

(46 citation statements)

References 16 publications

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“…This confirms the published observations from other high volume centres (Menon et al 2007; Graefen et al 2006; Savera et al 2006; Nielsen et al 2008; Kaul et al 2006). The current results are even superior in the younger patient group as compared to later publications.…”

Section: Discussionsupporting

confidence: 90%

“…However, longer follow up is still needed to ascertain biochemical recurrence- free survival in this cohort. Generally, these results are comparable with the published series in literature (Montorsi et al 2005; Graefen et al 2006; Savera et al 2006; Nielsen et al 2008; Kaul et al 2006; Chuang et al 2005; Alemozaffar et al 2012; Greco et al 2010; Mattei et al 2007). …”

Section: Discussionsupporting

confidence: 89%

“…This preservation of sexual function associated with intrafascial plane of dissection argues against the concept that the nerves in these fasciae innervate only the corpora cavernosa (Kaul et al 2006). OIF-RP offered less traction on NVBs which reinforces the concept of improved accuracy in preservation of the neurovascular bundles and prevention of neurapraxia which was also recently suggested to improve the potency outcomes by other surgeons (Nielsen et al 2008; Chuang et al 2005; Alemozaffar et al 2012). Furthermore, current study provided for the first time an evidence that patients with weak potency could profit from OIF-RP more than other nerve sparing surgeries.…”

Section: Discussionsupporting

confidence: 52%

See 2 more Smart Citations

Prospective comparison of one year follow-up outcomes for the open complete intrafascial retropubic versus interfascial nerve-sparing radical prostatectomy

et al. 2014

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Current work provides a prospective direct comparison between Open complete intrafascial-radical-prostatectomy (OIF-RP) and interfascial-RP in all outcomes in single centre series. Both techniques were done prospectively in 430 patients. Inclusion criteria for OIF-RP (n=241 patients) were biopsy Gleason-score ≤6 and PSA ≤10 ng/ml while for interfascial-RP (n=189) were Gleason-score ≤7 and PSA ≤15. The perioperative parameters (e.g. operative time, complications etc.), pathologic results, surgical margins and revisions were reviewed. Pre- and postoperative (3 and 12 months) evaluation of continence and potency was performed. All patients have preoperative IIEF-score of ≥15. Continence was classified as complete (no pads), mild (1-2 pads/day) and incontinence (>2 pads/day). Median patients’ age was 63.7 vs. 64.5 years for OIF-RP vs. Interfascial-RP, respectively. Preoperative PSA-level was significantly lower in OIF-RP (5.8 vs. 7.1), otherwise, similar perioperative data in both groups except for more frequent pT3-tumors in interfascial-RP group (18%). No statistical significance regarding continence was observed between OIF-RP vs. Interfascial-RP groups at 3 (82% vs. 85%) and 12 months (98% vs. 96%) postoperatively. Potency rates (IIEF ≥15) after OIF-RP were 96% (≤55 years), 72% (55-65), and 75% (>65 years) at 12 months. The respective rates for interfascial-group were 58%, 61% and 51%. There was an advantage for OIF-RP potency-outcomes without significance over Interfascial-RP in weak potency patients (IIEF=15-18). We conclude that OIF-RP is associated with better functional results without compromising early oncological results compared to interfascial-RP. Complete preservation of periprostatic fasciae provides significantly better postoperative recovery of sexual function even for weak potency patients. Longer follow-up is mandatory to further evaluate the outcome results of this technique.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 52%

See 1 more Smart Citation

Prospective comparison of one year follow-up outcomes for the open complete intrafascial retropubic versus interfascial nerve-sparing radical prostatectomy

et al. 2014

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“…Recently, Nielsen et al [36] modified initial poit of view introducing a link between apical dissection and nerve-sparing. In fact the high anterior release of the levator fascia in open radical retropubic prostatectomy provided excellent oncological results (1.3% positive margin) and was associated with improved postoperative sexual function (93% versus 77%).…”

Section: Resultsmentioning

confidence: 99%

Specimen Orientation by Marking the Peripheral End: (Potential) Clinical Advantages in Prostate Biopsy

et al. 2011

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The aim of this paper is to identify advantages that could be obtained by orientation of the biopsy specimen using the marking technique. We reviewed our experience (4,500 cases) and the published literature. The peripheral (proximal) end of the fresh specimen is marked with ink soon after needle delivering in a few minutes. It is performed easily in association with pre-embedding method. Five potential clinical advantages were identified: (1) tumor localization, (2) atypical lesions localization and planning rebiopsy strategy, (3) planning surgical strategy, (4) selection criteria for focal therapy and active surveillance, and (5) cost reduction. Peripheral end marking is low cost, easy and reproducible. It drives several potential advantages in cancer diagnosis or isolated atypical lesions, in particular, spatial localization within the biopsy (transition versus peripheral zone, anterior versus posterior, subcapsular versus intraparenchima, and extraprostatic extension) should be easy and reliable. We can add a new pathological parameter: pathological orientation or biopsy polarity.

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“…Levator ani fascia is the outermost fascial layer of the prostate laterally. In most cases, there is an inner fascia called prostatic fascia which is usually multilayered [1819]. Both these layers; the levator ani fascia and the prostatic fascia constitute the periprostatic fascia.…”

Section: Fascial Anatomy Of Prostatementioning

confidence: 99%

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

2016

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Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes.

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High Anterior Release of the Levator Fascia Improves Sexual Function Following Open Radical Retropubic Prostatectomy

Abstract: Unilateral or bilateral high anterior release of the levator fascia in open radical retropubic prostatectomy provides excellent oncological results and is associated with improved postoperative sexual function.

Cited by 105 publications

References 16 publications

Prospective comparison of one year follow-up outcomes for the open complete intrafascial retropubic versus interfascial nerve-sparing radical prostatectomy

Prospective comparison of one year follow-up outcomes for the open complete intrafascial retropubic versus interfascial nerve-sparing radical prostatectomy

Specimen Orientation by Marking the Peripheral End: (Potential) Clinical Advantages in Prostate Biopsy

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

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