High Anterior Release of the Levator Fascia Improves Sexual Function Following Open Radical Retropubic Prostatectomy

Matthew E. Nielsen, Edward M. Schaeffer, Penny Marschke, Patrick Walsh

Research output: Contribution to journalArticle

Abstract

Purpose: Recent anatomical studies have shown that branches of the cavernous nerves running adjacent to the prostate at the apex travel more anteriorly than previously recognized. Outcomes of robot assisted radical prostatectomy suggest improved postoperative sexual outcomes following high anterior release of the levator fascia. We prospectively evaluated the effect of high anterior release on oncological and sexual function outcomes following open radical retropubic prostatectomy. Materials and Methods: A total of 167 patients with clinically localized prostate cancer with a preoperative Sexual Health Inventory for Men score of greater than 21 underwent radical retropubic prostatectomy with bilateral nerve sparing and selective high anterior release, as performed by a single surgeon. Data on postoperative sexual function were collected by an independent third party. Sexual function outcomes at 12 months were defined as 1) a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score of 4 or greater and 2) a Sexual Health Inventory for Men score of 22 or greater. Results: Because unilateral high anterior release was equivalent to bilateral high anterior release for both definitions (p >0.3), they were combined into 1 group for analyses. Patients undergoing high anterior release were more likely to achieve a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score of 4 (93% vs 77%, p = 0.007), and a Sexual Health Inventory for Men score of 22 or greater (70% vs 54%, p = 0.07) at 1 year. Return to baseline (a Sexual Health Inventory for Men score of 22 or greater) was even higher among patients receiving high anterior release who were more sexually active (greater than 1 attempt per week) preoperatively (78% vs 52%, p

Original languageEnglish (US)
Pages (from-to)2557-2564
Number of pages8
JournalJournal of Urology
Volume180
Issue number6
DOIs
StatePublished - Dec 2008

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Fascia
Reproductive Health
Prostatectomy
Equipment and Supplies
Prostate
Prostatic Neoplasms

Keywords

  • prostate
  • prostatectomy
  • prostatic neoplasms
  • sexual dysfunction, physiological

ASJC Scopus subject areas

  • Urology

Cite this

High Anterior Release of the Levator Fascia Improves Sexual Function Following Open Radical Retropubic Prostatectomy. / Nielsen, Matthew E.; Schaeffer, Edward M.; Marschke, Penny; Walsh, Patrick.

In: Journal of Urology, Vol. 180, No. 6, 12.2008, p. 2557-2564.

Research output: Contribution to journalArticle

Nielsen, Matthew E. ; Schaeffer, Edward M. ; Marschke, Penny ; Walsh, Patrick. / High Anterior Release of the Levator Fascia Improves Sexual Function Following Open Radical Retropubic Prostatectomy. In: Journal of Urology. 2008 ; Vol. 180, No. 6. pp. 2557-2564.
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abstract = "Purpose: Recent anatomical studies have shown that branches of the cavernous nerves running adjacent to the prostate at the apex travel more anteriorly than previously recognized. Outcomes of robot assisted radical prostatectomy suggest improved postoperative sexual outcomes following high anterior release of the levator fascia. We prospectively evaluated the effect of high anterior release on oncological and sexual function outcomes following open radical retropubic prostatectomy. Materials and Methods: A total of 167 patients with clinically localized prostate cancer with a preoperative Sexual Health Inventory for Men score of greater than 21 underwent radical retropubic prostatectomy with bilateral nerve sparing and selective high anterior release, as performed by a single surgeon. Data on postoperative sexual function were collected by an independent third party. Sexual function outcomes at 12 months were defined as 1) a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score of 4 or greater and 2) a Sexual Health Inventory for Men score of 22 or greater. Results: Because unilateral high anterior release was equivalent to bilateral high anterior release for both definitions (p >0.3), they were combined into 1 group for analyses. Patients undergoing high anterior release were more likely to achieve a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score of 4 (93{\%} vs 77{\%}, p = 0.007), and a Sexual Health Inventory for Men score of 22 or greater (70{\%} vs 54{\%}, p = 0.07) at 1 year. Return to baseline (a Sexual Health Inventory for Men score of 22 or greater) was even higher among patients receiving high anterior release who were more sexually active (greater than 1 attempt per week) preoperatively (78{\%} vs 52{\%}, p",
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