Jim Hu, MD, discusses new posterior approach to nerve-sparing prostatectomy

Data published in JU Open Plus suggest that a new posterior nerve-sparing approach during robotic-assisted radical prostatectomy (RARP) could allow men to preserve their sexual function after surgery without compromising surgical margins or adverse events.¹

In a recent interview with Urology Times®, Jim C. Hu, MD, MPH, discussed the functional advantages of the technique—a posterior approach to endopelvic neurovascular total sparing (PATENTS)—which may improve recovery of sexual function through preservation of anterolateral periprostatic tissue.Hu is a professor of urology and the director of robotic surgery at Weill Cornell Medicine in New York, New York.

For the study, the investigators retrospectively reviewed 495 RARPs, of which 278 were conventional anterior nerve-sparing and 217 were PATENTS. The median follow-up for each cohort was 10 months (IQR, 3 to 21) vs 5 months (IQR, 3 to 15), respectively (P < .001).

Patients in the PATENTS cohort had a shorter duration to erections sufficient for intercourse compared with those in the conventional arm (P = .022). Further, after adjustment, PATENTS was associated with improved erections firm enough for intercourse (HR, 2.3, CI, 1.45 to 3.68, P < .001), erections firm enough for sexual activity (HR, 1.5; CI, 1.21 to 1.96, P < .001), and any partial erections (HR, 1.4; CI, 1.13 to 1.63, P < .001).

There were no significant differences in margin status (P = .234) or adverse events (P = .933) between the 2 study arms.

REFERENCE
1. Wald G, Posada L, Suzman E, et al. Posterior Approach to Endopelvic Neurovascular Total Sparing Robotic-Assisted Radical Prostatectomy Improves Recovery of Erectile Function. JU Open Plus. 3(12):e00154, 2025. doi:10.1097/JU9.0000000000000394