Dear Sirs,
    
    In prostatic cancer, the erection potency after surgery is dependent upon patient's age, tumor stage and bilateral or unilateral nerve sparing radical prostatectomy. The patients eligible for nerve sparing radical prostatectomy are limited to the following criteria: younger than 65 years of age, pathological grading < 7 Gleason score and PSA concentration less than 10 ng/mL. From October 1997 to August 2003, a total number of 23 cases of laparoscopic radical prostatectomy (LRP) have been performed in this hospital, in whom 8 cases, aged 50 years ~ 65 years with PSA values of 4 ~ 10 (8.01.6) ng/mL, had bilateral nueurovascular bundles preservation. Their clinical stages included 3 cases of T1b, 3 cases of T2a and 2 cases of T2b. The median Gleason score of the biopsy specimens was <7. Before surgery all patients had a reasonable erectile strength and the erectile function validated questionnaires (IIEF5) averaged 21.7. The nerve sparing radical prostatectomy was performed according to the Monsouris technique (Guillonneau B, Balancien G. Laparoscopic radical prostatectomy: The Montsouris experience. J Urol 2000; 163: 418-22). IIEF 5 and rigiscan tests were performed 6, 12 and 18 months after surgery (Guo YL, Xin ZC. Male sexual dysfunction. Beijing: Beijing Medical University Publisher; 2002. p197-8). The surgical margin was negative and there was no urinary incontinence in all the patients. Erectile function was regained in 1 (12.5 %), 4 (50 %) and 6 (75 %) patients at 6 months, 12 months and 18 months after surgery, respectively. The degree of tumescence was 50 %, 70.5 % and 74 %, respectively, in the 6 patients with recovered erectile function. Patients with 70 % rigidity had IIEF scores averaged 22.35. With laparoscopy, the magnified anatomical images facilitate the identification and dissection in the preservation of neurovascular bundles in comparision with the retropubic radical prostatectomy. Our initial experience supports the result of Katz et al. (Katz R, Salomon L, Hoznek A, de la Taille A. Patient reported sexual function following laparoscopic radical prostatectomy. J Urol 2002; 168:2078-82).
    
    Xin Gao, Jiang-Guang Qiu, Bing Zhang, Yu-Bing Cai, Liang-Qin Hong
    Department of Urology, Third Affililated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
    E-mail: gaoxin44@vip.163.com

Full Text |