Nerve-Sparing Radical Prostatectomy
The preservation of these nerves are critical to maintaining erections after surgery. In the majority of cases, nerve-sparing prostatectomy can be performed. In some clinical situations in which more extensive cancer requires nerve removal, a sural nerve graft can be performed.
In the sural nerve grafting procedure, a piece of nerve from the lateral part of the ankle is harvested and tied into the stump of the resected nerve in the pelvis. Studies suggest that this permits the maintenance of erections, although one or both nerves may be removed.
After the Procedure
- One week after surgery: You will return to the clinic to have a post-operative check, and your staples will be removed. At this point, we will review your final pathology. The catheter will remain in.
- 10-14 days after surgery: This appointment is for a voiding trial and catheter removal. After the catheter is removed for either surgical approach, we encourage the use of Kegel exercises that are designed to increase muscle strength of the urinary sphincter and pelvic floor. Typically, men who do these exercises notice a marked improvement in their incontinence within four to six weeks after the catheter is removed.
Kegel exercises are performed by contracting the muscle that one uses to control the urinary sphincter and holding it for three seconds. The muscle is then relaxed. This contraction is also felt in the rectum and perineum (the muscles behind the scrotum and in front of the rectum). This should be repeated 20 times per hour while you are awake and may be done while you are sitting, standing, watching TV or related activities.
The second week after the catheter is removed, we would like you to increase the amount of time you contract the sphincter to four seconds. during the third week, and in progressive weeks, increase the time of contraction from five to 10 seconds. You will note a gradual increase in the ability to control your urine.
Generally, this is better done in the morning than in the afternoon. We will also discuss sexual activity, erections and the use of Viagra/Cialis during this visit. If you have any problems urinating or note a marked decrease in urinary stream, please contact your physician. This may suggest that there is some narrowing in the healing area between the bladder and the urethra