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Thinagaran et al. Mini-invasive Surg 2021;5:46 https://dx.doi.org/10.20517/2574-1225.2021.53 Page 9 of 18

Figure 11. Bladder drop with division of the urachus.

Figure 12. Bladder drop with dissection continuing down to the pubic symphysis.

Urinary diversion
The next step is the urinary diversion, which is commonly either ileal conduit or orthotopic neobladder.
The neobladder is in keeping with a NS approach by aiming to maximise functional outcomes with minimal
effect on body image, analogous to the pelvic organ sparing approach in women. By avoiding a urostomy
bag, as well as reducing the risk of erectile dysfunction as much as possible, the combined result of male NS
and neobladder will facilitate a return to sexual activity.

Nerve sparing technique
[11]
With the trizonal neuroanatomy described above in mind , the NS technique begins once the SVs
dissection starts. Avoidance of cautery and clipping small vessels for hemostasis prevents injury to the cell
bodies in the PNP, especially around the middle and the tips of the SVs. As the dissection continues
forward, vessels may be clipped as close as possible to the prostate, again avoiding cautery with athermal
dissection. Once at the base of the prostate, the lateral fascial layer that contains the ANPs, is divided and
released high up on the prostate’s surface and dissected away from the prostate laterally, to prevent injury to