Hydrodissection of neurovascular bundles during open radical prostatectomy improves postoperative potency

Purpose: Preservation of the neurovascular bundle during radical prostatectomy is important for postoperative erectile function. We determined whether hydrodissection of the neurovascular bundle during radical prostatectomy would result in improved erectile function postoperatively.

Materials and methods: Included in the study were 253 consecutive men who underwent nerve sparing radical prostatectomy, as done by 1 high volume surgeon (MIP). The first 117 and the next 136 men underwent standard dissection and hydrodissection, respectively, of the neurovascular bundle. In all men erectile function was evaluated by Sexual Health Inventory for Men score preoperatively, and 6 weeks and 6 months postoperatively. Time needed to achieve successful intercourse was also determined.

Results: In men with bilateral neurovascular bundle preservation mean Sexual Health Inventory for Men scores in the hydrodissection group were higher than in the standard dissection group by 2.8 at 6 weeks and by 3.5 at 6 months (p <0.05). In men with unilateral partial neurovascular bundle resection there was also significant improvement between the hydrodissection and standard dissection groups at 6 weeks and 6 months (p <0.05). Men with bilateral neurovascular bundle preservation who underwent hydrodissection and standard dissection required a median of 3 and 6 months, respectively, to achieve successful sexual intercourse with or without a phosphodiesterase-5 inhibitor (p <0.05). A difference was also observed in men who underwent partial neurovascular bundle resection. Hydrodissection was an independent predictor of time to successful intercourse on multivariate Cox regression analysis.

Conclusions: Hydrodissection of the neurovascular bundle during open radical prostatectomy improves postoperative Sexual Health Inventory for Men scores and the time needed to achieve successful intercourse.