RSS feedNerve-sparing prostatectomy results
Harley Street Urology is taking part in a unique study to assess the long term effectiveness of the nerve-sparing prostatectomy. The study involves measuring index patients who have undergone nerve-sparing surgery.
What is a nerve-sparing prostatectomy?
The nerve-sparing prostatectomy is a specialist procedure designed to safely remove the prostate while minimising damage to adjacent nerves.
Traditional prostate surgery, known as an open radical prostatectomy, resulted in long term incontinence and erectile dysfunction. This is because the surgeon used wide margins when removing the prostate and consequently adjacent nerves were divided and damaged.
More recently, a small number of surgeons with extensive experience in this field, introduced a new approach called nerve-sparing surgery. If patients have organ confined, early stage prostate cancer, it is possible for an experienced surgeon to safely remove the prostate without dividing and damaging adjacent nerves.
How are index patients chosen?
It is hard to accurately measure the effectiveness of nerve-sparing surgery. Reported success rates vary depending upon the patients who are being assessed. If, for example, a surgeon reports on rates for younger patients who are motivated to continue sexual intercourse, the results will be different to a broad group including older patients and those with erectile dysfunction before surgery.
Although a growing number of surgeons offer nerve-sparing surgery, it is difficult for patients to evaluate what is meant by this term or to compare the success rates of different surgeons.
Also, the terminology used and the way it is understood varies widely. Some reports state 90 per cent ‘erectile recovery’. However, the term commonly refers to any degree of penile enlargement, although not necessarily sufficient for full sexual intercourse. Patients commonly interpret ‘erectile recovery’ as a return to normal sexual activities, so there can be a gap between expectation and the reality following surgery.
For patients at Harley Street Urology, an index patient is defined in the following terms:
- Full erectile function before surgery
- Motivation to continue sexual intercourse after surgery
- Prostate cancer graded and staged as being safe for nerve-sparing approach
How does the index study of nerve-sparing patients work?
Once a person becomes an index patient, his post-operative recovery is recorded as part of the study. We use a number of key measures to assess the effectiveness of surgery and better understand the relationship between the procedure and subsequent recovery:
What happens if I am not classified as an index patient?
About 30 per cent of our patients are classified as index patients. If you do not become part of the study this may be because the grading and location of your prostate cancer mean full nerve-sparing surgery cannot be safely undertaken. The safe treatment of cancer is the first priority. Your own motivation will be carefully discussed during your initial consultations. However, if you are not an Index patient, you will receive exactly the same after care and the same assessments will be undertaken.
We have produced a publication with our full nerve-sparing prostatectomy results which is available for all patients and clinicians. For a copy, please contact us.