Question
A 68-year-old man comes to the physician for a wellness visit. Physical examination shows an enlarged and nodular prostate. Laboratory studies show elevated levels of prostate-specific antigen. A prostate biopsy confirms the diagnosis of prostate cancer and radical prostatectomy is planned. This patient should be counseled on the increased risk of injury to which of the following structures?
| A. | Cavernous nerve |
| B. |
Superior vesical artery |
| C. |
External anal sphincter |
| D. |
Hypogastric nerve |
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Correct Answer � A Explanation |
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- Radical prostatectomy involves complete removal of the prostate, including the prostatic capsule, the seminal vesicles, and the vas deferens.
Cavernous nerve
- The cavernous nerve can be injured during radical prostatectomy.
- The resulting erectile dysfunction is one of the most feared complications of radical prostatectomy, but advances in urological surgery have enabled safer approaches that have significantly reduced the risk of permanent impotence.
Superior vesical artery
- The superior vesical artery courses along the upper part of the bladder.
- This course keeps it safely away from the surgical field typically involved in radical prostatectomy.
- In modern prostate surgery, the risk of vascular injury is roughly 0.2%, making this a rare complication.
External anal sphincter
- The external anal sphincter is not at risk during radical prostatectomy.
- This structure can be compromised during traumatic vaginal births that lead to perineal lacerations.
- Radical prostatectomy can, however, pose a risk to the external urinary sphincter.
Hypogastric nerve
- Injuries to the hypogastric nerve are very uncommon in radical prostatectomy.
- The course of this nerve is much too proximal to be compromised in the typical surgical approach to the prostate.