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Sir,

We report a different experience to that of Marien and Lepor [1]; first, we commend the authors on their excellent results for continence and potency after radical retropubic prostatectomy (RRP). However, in their report the authors claim that there is no advantage for continence after nerve-sparing (NS) open RRP. Also, the data presented were recorded at 24 months after RRP, which is good for the potency rates but is less useful for continence.

We recently compared 140 patients having intrafascial NS (group A, 70 men) and no NS (group B, 70 men) endoscopic extraperitoneal RP (EERPE). This procedure was described previously [2]. All patients had their catheter removed at 5 days after EERPE, and at 7 days they all had a pad test. The preliminary results at 3 months showed that incontinence, measured as the weight of urine in the pad, was significantly less in patients having a bilateral NS procedure, with a mean number of pads and urine weight in group A and B of 3.51 and 5.92, and 75.0 and 285.5 g, (P < 0.001 and <0.006), respectively. This was also confirmed by the recorded pad usage at 3 months, in categories of none, 1–2 or >2 pads, in group A and B of 74%, 21% and 5%, and 63%, 23% and 15%, respectively. This observation is supported by a previously published series of 1300 patients [2]. There was a faster return to continence in the patients who had NS. Interestingly, the longer term continence at 12 months showed no difference [2].

There have been many recent advances in prostate surgery and now open, laparoscopic and robotic RP all show effective disease control. It is the refinements in technique that are now making an impact on the complication rates. Quality-of-life studies show that it is the early return to continence that makes the greatest difference to the patient and this must therefore be the focus for the future [3]. Our results would suggest that a greater effort in preserving the periprostatic nerves results in better outcomes for potency and continence. This is further supported by Catarin et al.[4], who recently showed that damage to the afferent autonomic innervation of the urethra might have a role in the continence mechanism after NS RRP. We accept that the two studies differ in surgical technique (comparing open NS RRP with NS EERPE) but the message that NS surgery does not improve continence is not our experience in Leipzig.