In radical prostatectomy, the nerve-sparing technique preserves which neurovascular bundle, and what functional outcome does this most critically influence?

• A Inferior hypogastric plexus bundles running medial to the seminal vesicles; preserves bladder continence
• B Pelvic splanchnic nerves (S2-S4) lying posterior to the rectum; preserves rectal function
• C Prostatic plexus branches along the anterior prostate surface; preserves urinary continence
• D Neurovascular bundles of Walsh running posterolateral to the prostate within the lateral prostatic fascia; preserves erectile function ✓

Explanation

The neurovascular bundles (NVBs) of Walsh lie posterolateral to the prostate within or adjacent to the lateral prostatic fascia, at the 5 and 7 o'clock positions. These carry parasympathetic cavernous nerves from the pelvic plexus (S2-S4 sacral roots) and are critical for erectile function. Anatomical nerve-sparing radical prostatectomy, pioneered by Walsh, preserves these bundles by dissecting in the correct fascial plane, improving potency rates to 70-90% in younger men with bilateral preservation. Continence depends predominantly on external urethral sphincter preservation during apical dissection.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.