The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis

No AccessJournal of UrologyReview Article1 Oct 2017The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis Laura N. Nguyen, Linden Head, Kelsey Witiuk, Nahid Punjani, Ranjeeta Mallick, Sonya Cnossen, Dean A. Fergusson, Ilias Cagiannos, Luke T. Lavallée, Christopher Morash, and Rodney H. Breau Laura N. NguyenLaura N. Nguyen Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada More articles by this author , Linden HeadLinden Head Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author , Kelsey WitiukKelsey Witiuk Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author , Nahid PunjaniNahid Punjani Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author , Ranjeeta MallickRanjeeta Mallick Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author , Sonya CnossenSonya Cnossen Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author , Dean A. FergussonDean A. Fergusson Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author , Ilias CagiannosIlias Cagiannos Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada More articles by this author , Luke T. LavalléeLuke T. Lavallée Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Financial interest and/or other relationship with Sanofi and Ferring. More articles by this author , Christopher MorashChristopher Morash Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada More articles by this author , and Rodney H. BreauRodney H. Breau Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3344AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We summarize published data on associations between cavernous neurovascular bundle preservation (nerve sparing) during prostatectomy and positive surgical margins, erectile function, urinary function and other patient reported outcomes. Materials and Methods: A systematic literature search of MEDLINE®, Embase® and Cochrane Reviews databases was performed for interventional or observational studies published between 2000 and 2014. English language articles that compared clinical outcomes of patients undergoing nerve sparing and nonnerve sparing radical prostatectomy were included. Meta-analyses were performed to calculate pooled relative risk estimates for positive surgical margins, erectile dysfunction and urinary incontinence in nerve sparing and nonnerve sparing groups. Sensitivity analyses compared outcomes among unilateral and bilateral nerve sparing vs nonnerve sparing groups. Results: Of the 1,883 articles identified, 124 studies (73,448 patients) were included in the analysis. Nerve sparing did not increase the risk of positive surgical margins in patients with pT2 (RR 0.92, 95% CI 0.75–1.13) or pT3 disease (RR 0.83, 95% CI 0.71–0.96), potentially due to appropriate patient selection. The risk of incontinence was lower in nerve sparing cases (RR 0.75, 95% CI 0.65–0.85 and RR 0.61, 95% CI 0.44–0.84) at 3 and 12 months, respectively. The relative risk of erectile dysfunction with nerve sparing was 0.77 (95% CI 0.70–0.85) at 3 months and 0.53 (95% CI 0.39–0.71) at 12 months. 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Link, Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byEastham J, Auffenberg G, Barocas D, Chou R, Crispino T, Davis J, Eggener S, Horwitz E, Kane C, Kirkby E, Lin D, McBride S, Morgans A, Pierorazio P, Rodrigues G, Wong W and Boorjian S (2022) Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part II: Principles of Active Surveillance, Principles of Surgery, and Follow-UpJournal of Urology, VOL. 208, NO. 1, (19-25), Online publication date: 1-Jul-2022.Kumar R, Fergusson D, Lavallée L, Cagiannos I, Morash C, Horrigan M, Mallick R, Stacey D, Fung-Kee-Fung M, Sands D and Breau R (2021) Performance Feedback May Not Improve Radical Prostatectomy Outcomes: The Surgical Report Card (SuRep) StudyJournal of Urology, VOL. 206, NO. 2, (346-353), Online publication date: 1-Aug-2021.Soeterik T, van Melick H, Dijksman L, Stomps S, Witjes J and van Basten J (2020) Nerve Sparing during Robot-Assisted Radical Prostatectomy Increases the Risk of Ipsilateral Positive Surgical MarginsJournal of Urology, VOL. 204, NO. 1, (91-95), Online publication date: 1-Jul-2020.Seftel A (2017) Re: Neurovascular Bundle Size Measured on 3.0-T Magnetic Resonance Imaging is Associated with the Recovery of Erectile Function after Robot-Assisted Radical ProstatectomyJournal of Urology, VOL. 198, NO. 5, (965-965), Online publication date: 1-Nov-2017. Volume 198Issue 4October 2017Page: 760-769Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsmargins of excisionerectile dysfunctionurinary incontinenceprostatectomyAcknowledgmentsRisa Shorr, Alexandra Davis, and the Ottawa Hospital Library and Learning Centre developed and executed the electronic search strategies.MetricsAuthor Information Laura N. Nguyen Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada More articles by this author Linden Head Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Kelsey Witiuk Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Nahid Punjani Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Ranjeeta Mallick Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Sonya Cnossen Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Dean A. Fergusson Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Ilias Cagiannos Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada More articles by this author Luke T. Lavallée Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Financial interest and/or other relationship with Sanofi and Ferring. More articles by this author Christopher Morash Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada More articles by this author Rodney H. Breau Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...