What would happen if neurovascular bundles were left behind in radical retropubic prostatectomy?

Aim: To evaluate whether nerve-sparing radical prostatectomy (NSRP) results in a residual tumor in the remaining neurovascular bundle (NVB). Materials and methods: A total of 88 patients underwent bilateral NSRP. The ipsilateral NVB was excised uni-/bilaterally on the tumor side, separately. Factors affecting NVB involvement were evaluated. Results: The mean patient age and preoperative serum prostate specific antigen (PSA) were 63.8 +/- 6.2 years (49-76) and 12.9 +/- 9.4 ng/mL (2.4-45.5), respectively. Digital rectal examination (DRE) suggested nodules in 34 patients (38.6%). Uni- and bilateral NVB resections were performed on 40 (45.5%) and 48 patients (54.5%), respectively, according to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) pathology findings. NVB dissection was performed easily in all patients. The only factors correlated with tumor presence in the remaining NVB were a positive DRE finding (85.7% vs. 34.6%, P = 0.012), final pathology Gleason score (P = 0.016), capsular penetration/extracapsular extension (P = 0.001), and seminal vesicle invasion (P = 0.002). NVB involvement was detected in only 7(8%) patients (6 had bilateral NVB resections), and the mean PSA was 19 +/- 14.3 ng/mL in this group. The number of biopsy cores ranged between 6 and 27. In 15 patients, prostate cancer was diagnosed on repeat biopsies, and none had NVB invasion on pathology. Conclusion: NVBs seem to have been excised unnecessarily on the tumor side (81 out of 88 patients). No preoperative parameter other than DRE status was correlated with NVB involvement. Further criteria should be evaluated in performing NSRP.