At age 45, Robert Daly's diagnosis of prostate cancer came as a complete surprise. Of all the health problems Mr. Daly was worried about, prostate cancer was low on the list.Suddenly, Mr. Daly faced a dilemma that thousands of men diagnosed with prostate cancer confront each year. His internist recommended surgery as the best option to cure the cancer (90% of patients with similar tumors lived at least 10 years after the surgery).

"Recognizing thatradical prostatectomyis the most effective cure for prostate cancer, what I've been trying to do is minimize the complications associated with the procedure." - Herbert Lepor, MD Professor and Chairman of Urology.

As a husband and father of two young children, Mr. Daly's primary concern was beating the cancer, but he was also worried about the risk of impotence and incontinence. "I was very fearful that the surgery would affect my sexual function and bladder control," says Mr. Daly. He was referred to Herbert Lepor, MD, a urologic surgeon at NYU Medical Center with an international reputation for performing radical prostatectomy using nerve-sparing techniques that greatly reduce the risk of complications.

Pioneering Research

Mr. Daly learned that Dr. Lepor had performed hundreds of these procedures and was one of the pioneers who, under the leadership of Patrick Walsh, MD, at Johns Hopkins, had revolutionized prostate surgery by demonstrating that it was possible to remove the prostate gland without sacrificing sexual potency.

Prior to this breakthrough, impotence invariably followed radical prostatectomy. The conventional wisdom was that this operation unavoidably caused injury to neurological or vascular pathways or both. This would severely impair normal erectile function.

A series of important clinical observations and advances in surgical technique in the late 1970s established the foundation for the nerve-sparing radical prostatectomy. Urologic surgeons had been working to reduce blood loss during prostatectomy by careful dissection and ligation of the dorsal vein complex to control bleeding. This allowed the surgery to be performed in a relatively bloodless field, in which even more meticulous dissections could be completed.

Following the surgery, younger patients began to report that they were still sexually potent, which indicated that the nerves stimulating erectile function can be preserved. Unfortunately, a detailed anatomic description of the nerves could not be found in the literature. Preliminary anatomical research, however, confirmed that these hair-thin nerves (the cavernous nerves) were located outside the capsule of the prostate gland.