Beschreibung:
The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes.We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”,“prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the referencelist of the included studies. Nerve-sparing techniques can be distinguished based on the fascialplanes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde orantegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release),the use of cautery, the application of traction and the number of the neurovascular bundles which arepreserved. Despite this rough categorisation, many techniques have been developed which cannot beintegrated in one of the categories described above. Moreover, emerging technologies have enteredthe nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximalextent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization ofthe correct planes remain the basic principles for achieving optimum functional outcomes. Given thatpotency and continence outcomes after radical prostatectomy are multifactorial endpoints in additionto the difficulty in their postoperative assessment and the well-documented discrepancy existingin their definition, safe conclusions about the superiority of one technique over the other cannot beeasily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.