Delineating the Anatomy

A major effort was launched by Dr. Walsh to modify the procedure to avoid the cavernous nerves while maintaining adequate surgical margins. A central task, undertaken by Dr. Lepor, was the painstaking effort to accurately chart the complex anatomy encompassing the prostate. This involved dissection and three dimensional reconstruction of the adult human pelvis in minute detail to determine precisely where the microscopic cavernous nerves are located. Many men find the prospect of lifelong impotence devastating. As a result, they may not select the most effective treatment. Dr. Lepor and colleagues presented the new discoveries about the pelvic anatomy, the cavernous nerves, and their location at the National Meeting of the American Urological Association in 1982. This research allowed Dr. Walsh, Dr. Lepor, and colleagues to refine the surgical techniques for preserving the nerves.

Perfecting Surgical Technique

These advances made it possible to greatly reduce the rates of impotence following radical prostatectomy for patients with localized prostatic cancer. However, knowledge of the anatomy and procedures alone is insufficient. To perform this operation successfully requires a great deal of surgical experience and skill. Dr. Lepor performs over 200 radical prostatectomies at NYU Medical Center annually; his patients are usually ready to go home within two days after surgery. Dr. Lepor's work has made it much easier for the patient to accept a recommendation of surgery. "The best chance of curing this cancer is to have the surgery, and now the operation is much safer and less traumatic than ever before," he says. "The risk of impotence is greatly reduced, and the likelihood of speedy and full recovery is extremely high." Additionally, NYU's physician-scientists are doing pioneering work in treating impotence, so even if this problem occurs, expert care is available to assist in the restoration of sexual function. A leader in this field is urologist Andrew McCullough, MD, who is investigating pharmacological and surgical therapies for erectile dysfunction.

mprovement of surgical technique in prostatectomy has led to another important benefit: reduction in incontinence. In fact, none of Dr. Lepor's patients has experienced total urinary incontinence.

Retention of Sexual Potency Depends on:

• Extent of the cancer
• Surgeon's skills
  
• Patient's age
  
• Prior state of sexual potency
  
• Level of interest in sexual activity