Radical pelvic surgery with preservation of sexual function.

Recent neuroanatomical findings make it possible to identify the pelvic plexus and branches that innervate the corpora cavernosa intraoperatively. These anatomical principles have been used to modify standard radical prostatectomy and cystoprostatectomy to prevent postoperative sexual dysfunction. Radical retropubic prostatectomy has been performed on 320 men, who have been followed for 1-5 years after surgery; 74% of these men are now potent after surgery. Positive surgical margins were present in 10% of the cases; the actuarial overall local recurrence at 5 years (with or without distant metastases) is 10%. These results are consistent with past experience and data reported elsewhere in the literature. Radical cystoprostatectomy has been performed on 25 men over the past 5 years. Pathologic evaluation of all specimens demonstrated negative surgical margins, no patient has developed local recurrence, and of the patients who had cystectomy alone, 83% are now potent after surgery. With application of these principles to colorectal surgery, similar favorable impact on quality of life with improved surgical accuracy may be possible.