Nerve Sparing Implant
The image shows an MRI fused onto an intraoperative ultrasound image. The red contour is that of the prostate as identified by intraoperative ultrasound. The nerves that control erection are labeled. The nerve on the left has been spared by sophisticated intraoperative treatment planning but the nerve on the right has been included in the treatment field because the cancer comes close to this nerve.
The neurovascular bundles that control erection run on either side of the prostate gland. These nerves cannot be seen under ultrasound but can be seen clearly with MRI. A preoperative MRI is therefore fused onto the real time ultrasound so that the nerves can be identified. Once identified, the radiation dose to one of the nerves can be reduced using intraoperative planning techniques provided that the biopsy report and Prostascint report show little or no cancer near that nerve. It is thought that radical prostatectomy nerve sparing surgery may improve potency rates. For nerve sparing brachytherapy it is thought that a reduction in dose may also improve potency rates. Nerve sparing brachytherapy is not possible with the old preplan technique. Dr Doggett is one of the first physicians in the world to use nerve sparing brachytherapy.