Veil of Aphrodite at the time of robotic prostatectomy

UroToday – AUA 2007 ABST[550] Curtain Dissection of the Lateral Prostatic Fascia and Potency Following Laparoscopic Radical Prostatectomy – A Veil of Mystery

Conclusions: CD produced a significantly higher potency rate at 1 month following LRP but similar rates thereafter, which are in step with previously reported values (Rozet, 2004). Notably, CD failed to reproduce the results of Menon et al. despite the advantage of avoiding cautery at all stages during NVB preservation in our patients. We believe that the merit of this technique is in allowing a clearer appreciation of the contour of the prostate base at the commencement of antegrade NVB dissection, rather than preserving important nerve fibres. This may explain the lower basal positive margin rate in the CD group of 0% vs 5.8% in control cases (p=0.007).

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ED and the Veil of Aphrodite

Dr. Menon gave a presentation at the Pacific Rim Robotics Conference on nerve preservation and the anatomical concept that he has named the veil of Aphrodite. After first reviewing the history of impotence after radical prostatectomy he described the latest modification of his techniques, which he claims further improves the preservation of potency. Originally, of course, radicals were associated with nearly 100% impotence until Dr. Walsh introduced the concept of “nerve sparing”. While Walsh has at times claimed very high rates of preservation, many others felt that preservation in perhaps 50-60% of patients having a nerve sparing represented excellent results. In the introductory remarks to his talk Dr. Menon cited several papers that quoted rates of “normal” erections of only 4-33% after nerve sparing. There is clearly room for improvement.

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