Work

Differential Impact of Four-Layer Nerve-Sparing Grades on Urinary and Nerve Functional Outcomes in Patients with Prostate Cancer Treated with Robot-Assisted Radical Prostatectomy

Year: 2026

Type: article

Abstract: BACKGROUND: The nerve-sparing (NS) technique may reduce urinary and erectile dysfunction in patients with localized prostate cancer undergoing robot-assisted radical prostatectomy (RARP). However, the influence of NS dissection depth on functional outcomes remains unclear. We aimed to evaluate the impact of NS grades, based on a four-layer dissection model, on urinary continence and nerve function using subjective and objective outcome measures. METHODS: This was a retrospective cohort of 600 consecutive patients undergoing RARP (December 2012-September 2023), with NS graded I-IV (intrafascial to extrafascial) using surgical records/videos. Maximum NS grade (mNSG) was defined as the highest grade on either side. Continence was defined as using no safety pad or only one safety pad/day. Urodynamic study and intraoperative electrical stimulation were used in a subset to evaluate urinary and nerve function. Associations between NS grade and outcomes were assessed using logistic regression. RESULTS: Patients with mNSG I showed significantly better continence at 3, 6, and 12 months (p < 0.001, p < 0.001, p = 0.017, respectively). A total number of both sides of ≥ 3 (NS grade I to IV = point 3 to 0) was also associated with better continence. mNSG I remained an independent predictor at 3 and 6 months. Urodynamic study parameters were largely comparable, except for higher voiding volume in mNSG I (p = 0.006). Greater preservation of intraurethral pressure after stimulation was observed in mNSG I. Limitations include the retrospective design and selection bias. CONCLUSIONS: Even unilateral intrafascial NS (mNSG I) may improve continence and nerve function. Layer-specific dissection may optimize outcomes after RARP.

Source: Annals of Surgical Oncology

DOI: 10.1245/s10434-026-20670-9