Nerve-sparing radical retropubic prostatectomy: techniques and clinical considerations

There are essentially two ways to accomplish nerve preservation during radical retropubic prostatectomy: the 'apical approach' described by Walsh and the so-called 'lateral approach', a simplified method where the dissection is initially conducted on the portion of the bundles that courses posterolateral to the prostate. Do the different techniques differ in the ability to preserve potency and in the positive surgical margins rate? No previous study has addressed this question. Above all, the preoperative and intraoperative indications to spare or not the nerves remain a matter of debate. The present review is an attempt to elucidate these questions in light of the current literature.