If we were to offer some friendly advice to men who are focusing on this aspect of the surgery, it would be this. Think about what’s really important! The primary goal here isn’t to preserve potency, but to get rid of the cancer in a careful but thorough way. Please keep that in mind. Men can remain potent even if one bundle is removed, and can still have normal sensation, sex drive, and orgasm even if both bundles are removed.

There is no way for the surgeon to know for certain beforehand whether or not the bundles can be spared; only during surgery is it truly possible to see where the cancer is. If the surgeon decides to preserve the nerve bundles, the tiny branches that connect the nerves to the prostate are divided carefully. If, however, one or both bundles must be widely excised, the nerve bundles are cut near the urethra and beside the rectum.

Next, the surgeon goes to work on the prostate, making a cut to separate it at the bladder neck, which links the bladder to the prostate. The seminal vesicles and vas deferens on both sides are also removed. The goal here is to remove as much surrounding tissue as possible along with the prostate. Finally, the surgeon must carefully rebuild the urinary tract, hooking up the bladder once again to the urethra and urethral sphincter, which is responsible for urinary control (this reconnection is called an anastomosis). The surgeon uses sutures, or stitches, to narrow the bladder neck so it matches the size of the urethra. The Foley catheter is left in place after the operation.


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