Anatomical aspects of the neurovascular bundle in prostate surgery

Over recent years, widespread prostate-specific antigen screening has resulted in a downwards stage migration of prostate cancer in developed nations, with most patients being diagnosed nowadays at a younger age with early organ-confined disease [1–3]. Radical prostatectomy has a proven survival benefit over conservative treatment [4, 5], and thus is the gold standard for the management of clinically localized prostate cancer. Hence, with more patients undergoing surgery, minimizing functional loss is of utmost importance. However, despite recent advances in surgical technique and technologies, return of erectile function sufficient for sexual intercourse at 1 year after surgery varies from 15 to 87 %, respectively, in contemporary series of radical prostatectomy [6–8]. For younger men, postprostatectomy erectile dysfunction (PPED) significantly affects their sense of masculinity and their daily interactions with women [9, 10]. Patient age, clinical and pathological stage of cancer, preoperative potency status, and aggressiveness of nerve-sparing are the most significant factors for recovery of potency after surgery [11–13]. Surgeon experience and surgical volume, penile ischemia and subsequent fibrosis, and veno-occlusive disease are also important for successful return of sexual function following surgery [14, 15].