nervesparing

Nerve-sparing, also spelled nervesparing, is a surgical approach that aims to protect autonomic nerve fibers during operations where these nerves are at risk of injury. The goal is to preserve functions such as erectile function, urinary continence, and bowel control after surgery. Nerve-sparing techniques are most commonly discussed in urologic oncology, but they are also used in colorectal and gynecologic surgeries where pelvic autonomic nerves are near the operative field.

In radical prostatectomy, for example, surgeons attempt to preserve the cavernous nerves and surrounding neurovascular bundles by careful dissection. Decisions about sparing depend on tumor extent, location, grade, and the patient’s baseline function. Preoperative imaging, such as multiparametric MRI, and intraoperative assessment help determine whether nerve-sparing is appropriate. The technique may involve robotic or microsurgical approaches, precise tissue handling, and minimizing thermal injury.

Techniques used to maximize nerve preservation include meticulous dissection along known nerve planes, preservation of supportive tissue around the neurovascular bundles, and careful use of energy devices. Where primary nerve preservation is not feasible, nerve grafting or reconstruction may be considered in some centers. The choice of approach is individualized, balancing the aim to maintain function with the need for complete cancer removal.

Outcomes vary with cancer characteristics and patient factors. In properly selected patients, nerve-sparing can improve postoperative erectile function and continence compared with non-nerve-sparing approaches, but it may carry a higher risk of positive margins or local recurrence if tumors involve the nerve pathways. Nerve-sparing requires specialized surgical expertise and thorough preoperative counseling about potential benefits and risks.