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Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy

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Posted 12/14/2013 11:49 AM (GMT -5)
Not sure if this has been posted before or not, but I thought I would share this as I believe it to be helpful information.  Here's the link:  http://www.goldjournal.net/article/S0090-4295(13)01040-6/abstract

The "Conlusion" for this was "The quality of Nerve Sparing significantly influences patient-defined urinary functional convalescence. Completely sparing at least 1 neurovascular bundle along with its supportive tissues has a dramatic effect on the recovery of urinary continence and quality of life in preoperatively potent men."

Perhaps this is common knowledge among those that are far more knowledgeable with Prostatectomy, but thought I would post this.

Posted 12/14/2013 2:48 PM (GMT -5)
Certainly makes sense--less damage better results.

Tom
Posted 12/14/2013 5:21 PM (GMT -5)
Im not getting the relationship between nerve sparing and continence, other then this study. They are two separate procedures. the proximity of the procedure, with an experienced surgern is nullifying. All things being equal in the operation, could you say lymph node dissection on the same patients, in addition to NS, would affect continence? What would be the result of the lymph node dissection, or LN no NS or NS no LN. the result would be the same in this pack of cohorts. I put no faith in studies, and that is what they require regardless of the institution or High mucky mucks, involved in them. Its kinda like soft drugs{MJ} for instance leading to hard . Probably 95 % of the cohorts, in that study, drink or drank milk at some time, ergo, Milk leads to hard drugs. Just thinking….. ps actually, the stiching of the urethra is quite distant in anatomical terms. Im open to learn what I am missing in my thinking. As I have a cursory knowledge of the details pf a prostectemy, robotic or open.
Posted 12/14/2013 10:30 PM (GMT -5)
Yoop,
Yes, we,ll get together when the weather warms up and burn some CCI mini-mags, velocitiors, stingers, and I have some Mexican "firecrackers". It's too cold now and at my age all my cousins are dying
Logo and I are almost the last of JFK's Camelot generation and tend to question studies and "evidence based science". My first reaction is whose evidence and whose science; I still remember nuclear fuel rods in Iraq.

Of course, I disagree with Logo since a prostate is pretty small and if a "good" surgeon can't preserve at least 1 nerve on a common basis then he's in the wrong profession. My uro told me that they wouldn't even attempt ns and that I would be incontinent life long; that's when I bolted. Anyway, Logo has presented some interesting information and I'm conflicted regarding the study. If the same doctor did all the procedures then I would tend to agree with the conclusion; if not then it's invalid due to the varying degree of surgeon's skill. Just my thoughts! Have a Merry Xmas!
Bill idea
Posted 12/15/2013 12:21 AM (GMT -5)
I am not saying that the study is necessarily invalid. I am saying that the study is not necessarily valid. A study requires faith, some more, some less. My understanding of a clinical trial, thanks to TC, is that it requires not, faith. And yes JFK"S Camelot, based more on our hope than reality, was a wonderful time. The moment of hope when and where ever it arises, suspends time and facts. I like it when it happens in my life, it, well… it gives me hope.
Posted 12/15/2013 1:00 PM (GMT -5)
My own experience doesn't bear out the study's conclusion. My surgeon spared the nerve bundle on the right side of my prostate and took out only part of the nerve bundle next to the apex of the prostate. Yet, I'm still incontinent more than 2 years past my surgery. And I'm still incontinent despite almost 10 months of pelvic floor rehabilitation which has strengthened my pelvic floor considerably.

My surgeon doesn't understand why I'm still incontinent because he told me he didn't have to cut into the bladder sphincter when he removed my prostate. He thought all I needed to regain continence was to strengthen my pelvic floor muscles but that hasn't happened. Something still isn't working right but I don't know that is (and neither does my doctor). I suffered from BPH for 10 years before my prostectomy; so maybe that has something to do with it. I had partial nerve sparing; so that isn't the answer either, in my case anyway.

Mike
Posted 12/17/2013 8:08 PM (GMT -5)
I have heard before that nerve recovery is believed to be associated with continence improvement.

It makes sense as, besides the erectile nerves, the neurovascular bundles contain nerves running to the rectum, prostate and levator ani musculature (i.e. one of the main muscles of the pelvic floor):

www.kenhub.com/en/library/anatomy/levator-ani
Posted 12/17/2013 11:32 PM (GMT -5)
Im believing NJS, he provided a clinic to me, on on urological anatomy. Good to see a post from ya, Trust all is well with you and yours.
Posted 12/18/2013 9:22 AM (GMT -5)
I am Gleason 9 and had both nerves spared with open RP by an excellent Johns Hopkins surgeon. I have no incontinence problems after 14 weeks and never wore more than one pad.

I guess this helps prove the point that nerve sparing, surgical excellence and continence go together like love and marriage and horse and carriage. It also tells me that open RP is good for nerve sparing because the surgeon can FEEL what he is doing, which is EXACTLY why my surgeon recommended it for me as a high risk Gleason 9.
Bob
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