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Nerve-Sparing Surgery for Prostate Cancer

Medically Reviewed by Michael W. Smith, MD on May 21, 2021

Not all surgeries for prostate cancer are the same. Depending on the location and size of your prostate tumor, a surgeon may recommend different ways to remove it. In some cases, they also remove nearby lymph nodes or seminal vesicles (glands that help make semen).

In a nerve-sparing prostate cancer surgery, also called a nerve-sparing prostatectomy, doctors avoid cutting nerves near your prostate. This gives you a better chance of keeping normal erections and urinary function when you recover.

What Is Nerve-Sparing Prostatectomy?

Tiny bundles of nerves on either side of your prostate control your erections. If your tumor is tangled around these nerves, your doctor may not be able to cut it out without cutting the nerves.

But if your cancer is all within your prostate or farther away from these nerves, your surgeon may be able to keep the nerves intact.

How Is the Surgery Done?

Like other surgeries for prostate cancer, nerve-sparing surgeries can be done a few different ways:

In a standard “open” surgery, your surgeon makes a cut in your abdomen from just below your navel to your pubic bone. Then they cut away your prostate and tumor. They carefully avoid nearby nerves.

In a laparoscopic (minimally invasive) surgery, surgeons make much smaller incisions, each less than half an inch. Then, they use laparoscopic tools and cameras to do the operation. The tools are inserted into your abdomen through narrow tubes.

In robotic-assisted nerve-sparing prostate cancer surgery, your surgeon makes a small cut in your abdomen and places robotic tools in the hole. They control the tools from a computer to do the operation.

Is It Safe?

As with any major surgery, nerve-sparing prostatectomy can have complications. Rarely, they may include:

  • Bleeding
  • Infection
  • Injuries to nearby organs

More common side effects from a prostatectomy are:

  • Urinary incontinence. This urine leakage may improve over time after your surgery.
  • Erection problems. It may take up to 2 years after surgery before your erections are fully back to normal.
  • Sterility. Because a prostatectomy cuts the connection between your testicles and urethra, you can no longer provide sperm for a biological child after this surgery.

What Can I Expect After the Surgery?

How long you’ll stay in the hospital depends on which type of nerve-sparing prostatectomy you have and how much your cancer has spread. But you’ll probably stay for one night. Your doctor will likely recommend that you avoid strenuous moves and heavy lifting for at least a month.

Even if you have a nerve-sparing prostatectomy, it can take months to know whether your erections and urinary function will return to normal. Your nerves may not work properly for a while after the operation.

How Well Does Nerve-Sparing Prostate Surgery Work?

Studies have found that in people with tumors that haven’t spread beyond their prostates, nerve-sparing surgery works just as well as the non-nerve-sparing type. When your surgeon can’t fully remove a tumor, it’s usually because it spread more than surgeons expected, not because the surgery was nerve-sparing.

But nerve-sparing surgeries are better than non-nerve-sparing ones at preventing some side effects and complications, since your nerves aren't cut.

One study found that men who get a nerve-sparing prostatectomy are almost twice as likely to end up with full urinary control after surgery, compared to those who have non-nerve-sparing surgery.

Another study showed that 60.8% of men who got non-nerve-sparing, robotic-assisted prostatectomy could have orgasms after recovery. But 90.7% of men who had the nerve-sparing operation could have orgasms after they recovered.

Show Sources

SOURCES:  

Johns Hopkins Medicine: “Radical Prostatectomy,” “Prostatectomy: What to Expect During Surgery and Recovery."
BJU International: “Nerve sparing can preserve orgasmic function in most men after robotic‐assisted laparoscopic radical prostatectomy,” “Nerve-sparing approach during radical prostatectomy is  strongly associated with the rate of postoperative urinary continence recovery.”

Prostate Cancer Foundation: “Interview with an Expert: Rehabilitating Your Penis.”

Urology: “Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique.”

American Society of Colon & Rectal Surgeons: “Laparoscopic Surgery - What Is It?”

Mayo Clinic: “Prostatectomy.”

Asian Journal of Urology: “Nerve-sparing robot-assisted radical prostatectomy: Current perspectives.”

University of Florida Health: “Robotic Nerve-Sparing Radical Prostatectomy.”

Journal of Urology: “Nerve-sparing radical prostatectomy: evaluation of results after 250 patients.”

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