What Is Nerve-Sparing Robotic Prostate Surgery? Can Erectile Functions Be Preserved?
One of the most important concerns of many men who are planned to undergo surgery for prostate cancer is how sexual functions will be affected.
One of the most frequently asked questions by patients is:
“Will my erection continue after surgery?”
The answer to this question is different for every patient. However, today, thanks to developments in robotic surgical technologies, it may be possible to preserve the nerves responsible for erection in suitable patients.
This approach is called nerve-sparing robotic radical prostatectomy.
Where Are the Nerves That Provide Erection Located?
The nerve bundles responsible for erectile function are located on both sides of the prostate gland.
These nerves:
- Enable erection to occur
- Play a role in transmitting signals to the penis
- Play an important role in the continuation of sexual functions
The ability to preserve these nerves during prostate cancer surgery is of great importance for erectile functions after surgery.
What Is Nerve-Sparing Surgery?
Nerve-sparing surgery is an operation performed by preserving the nerve bundles responsible for erection around the prostate as much as possible.
The aim can be summarized as:
- Completely treating the cancer
- Trying to preserve erectile functions
- Improving quality of life
However, cancer control is always the first priority.
Can Nerve-Sparing Surgery Be Performed in Every Patient?
No.
This decision is made entirely according to the characteristics of the disease.
In particular:
- Multiparametric prostate MRI results
- MRI fusion biopsy findings
- Location of the cancer
- Proximity of the tumor to the prostate capsule
- The patient’s age and expectations
are evaluated.
If the cancer is thought to be very close to the nerves, preserving the nerves may not be appropriate in order not to risk cancer control.
What Are Unilateral and Bilateral Nerve Preservation?
Unilateral Nerve Preservation
In cases where the cancer is concentrated on only one side, the nerve bundle on the opposite side may be preserved.
Bilateral Nerve Preservation
In patients whose cancer has suitable characteristics, both nerve bundles may be preserved.
In general, the probability of erectile functions returning is higher in patients who undergo bilateral nerve preservation.
However, every patient is different, and results vary according to personal characteristics.
Can Erectile Dysfunction Occur Even If the Nerves Are Preserved?
Yes.
This is an important point.
The anatomical preservation of the nerves does not mean that erectile functions will immediately return to olağan.
Temporary functional loss may develop in the nerves after surgery.
For this reason, the recovery process takes time in many patients.
When Do Erections Return?
Recovery time varies from person to person.
This process is affected by factors such as:
- Age
- Erection quality before surgery
- Additional health problems such as diabetes and vascular diseases
- Smoking
- Degree of nerve preservation
While improvement may be seen in the first months in some patients, this process may take longer in others.
Why Is Penile Rehabilitation Important?
Penile rehabilitation programs are applied in many patients after surgery.
In these programs:
- Medications such as tadalafil
- Vacuum devices
- Injection treatments when necessary
may be used.
The aim is to preserve the health of penile tissue and support the recovery process.
Does Nerve-Sparing Surgery Negatively Affect Cancer Treatment?
No, when appropriate patient selection is made.
With nerve-sparing robotic surgery performed by experienced surgical teams, both effective cancer control and preservation of functional outcomes can be targeted.
However, the priority in every patient is always the safe treatment of the cancer.
What Is the Goal of Çağdaş Prostate Cancer Surgery?
Today, the aim is not only to remove the prostate.
In çağdaş surgery, the goal is to:
- Achieve cancer control
- Preserve urinary control
- Preserve erectile functions as much as possible
- Maintain quality of life
For this reason, the treatment plan should be personalized for each patient.
Conclusion
Nerve-sparing robotic prostate surgery is a çağdaş surgical approach that can help preserve erectile functions in suitable patients.
Thanks to the precision provided by robotic technologies, much more successful results can be achieved today compared to the past in terms of both cancer control and preservation of functions that affect quality of life.
If surgery is being planned due to prostate cancer, it is very important to evaluate nerve preservation options and postoperative expectations in detail with an experienced urology specialist.
Assoc. Prof. Dr. Serdar Yalçın
Urology Specialist
Robotic Radical Prostatectomy • Nerve-Sparing Surgery • Prostate Cancer • Andrology • Robotic Urology