Nerve at Risk: A Narrative Review of Surgical Nerve Injuries in Urological Practice

Background: Iatrogenic nerve injuries (NIs) are an under-recognized complication of urological surgery. Though less common than vascular or organ damage, they may cause lasting sensory and motor deficits, significantly affecting patients’ quality of life. With increasing complexity in pelvic procedures, a consolidated understanding of nerve injuries is essential. Purpose: This review aims to synthesize current knowledge regarding peripheral and autonomic NIs in urological surgery, highlighting mechanisms of injury, associated procedures, preventative strategies, and treatment options. Scope: Focused on common urological interventions such as radical prostatectomy, cystectomy, pelvic lymphadenectomy, and reconstructive techniques, the review explores injuries from positional compression, traction, and intraoperative transection to their surgical management. Key Findings: The review categorizes nerve injuries into crush and transection types and details intraoperative signs and repair techniques. Skeletonization of nerves, avoidance of energy devices near neural structures, and prompt end-to-end anastomosis using 7-0 polypropylene are central to management. Adoption of novel sutureless nerve coaptation devices have also been described with promising outcomes. Early repair offers a better prognosis. New intraoperative technologies like NeuroSAFE during robotic-assisted procedures may enhance nerve preservation. Conclusion: Iatrogenic NIs, although rare, are clinically significant and often preventable. Prompt intraoperative recognition and repair are critical. Further research is warranted to develop standardized preventative protocols and enhance intraoperative nerve monitoring. A multidisciplinary approach, extended across surgical specialties, could improve outcomes and guide timely treatment of nerve injuries.