A selection from
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
by Patrick C. Walsh, M.D., and Janet Farrar Worthington
removed the prostate - the idea of "to make an omelet, you have to
break a few eggs." These nerves were the "broken eggs" - an unavoidable hazard, the price of curing cancer.
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It didn't make sense to me that the nerves from one organ would
run through another organ. But this had always been the assumption,
even in medical textbooks. One highly respected anatomy textbook,
for example, stated merely that the nerves that enable erection were
"extremely small, difficult to follow in the adult cadaver," and that
their location was known "merely through experimental studies."
Around this time, something unbelievable happened: In 1977,
one of my patients returned for a follow-up visit three months after
surgery and reported that he was totally potent. To me, this news was
staggering - how could this man be potent, if the nerves that control
potency were inside the prostate that I had removed? Furthermore, if
this could happen to one man, then why only this one? Why weren't all
men potent after radical prostatectomy? The key was finding these
elusive nerves. If we could just figure out where they were - and then
find a way to save them but still cure prostate cancer - then men
would no longer be faced with an either-or situation. They could be
cured of cancer, and remain potent.
If this were a detective novel, then here's where we would say
something like: "The place: Leiden, the Netherlands. The year: 1981.
Here's where the whole case blew wide open." And really, it did -
thanks to a urologist named Pieter Donker. I was in Leiden for a conference; Donker, who had recently retired as professor of urology
there, was studying anatomy, and tackling unanswered questions. No
one had successfully dissected the nerves to the bladder, because they
were difficult to identify in adults. However, these nerves are not
nearly so obscured in infants. I asked to see the laboratory where he
was working to trace these nerves, in a cadaver of a stillborn male
infant. I asked Donker if he knew what happened to the other end of
this plexus of nerves - the ones that controlled penile erection. "I've
never looked," he said. We got to work. Four hours later, we were jubilant: We could see clearly that the nerves were outside the capsule of
the prostate - and that, indeed, it was possible to completely remove
the prostate and preserve sexual function!
Over the next year, we worked together on this project long-
distance, and then we met again. In the infant cadaver, the location of
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