There is an obvious prevalence of disparity in opinions concerning the technique of nerve-sparing radical hysterectomy and its application despite agreement on the need to spare the pelvic autonomic nerve system during such radical operation. Understanding the precise three-dimensional anatomy of paracolpium and its close anatomical relationship to the components of pelvic autonomic nervous system is the key to perform the nerve-sparing radical hysterectomy. 42 consecutive patients with primary cervical cancers, who were operated in our institution between January 2017 and June 2019 were analyzed with concerning on surgical, urinary functional and short-term oncologic outcomes. Two thirds of patients had locally advanced tumor (T> 40 mm or pT≥ IIA2) with a median tumor size of 44.1 mm. The nerve-sparing radical hysterectomy combined with the complete recovery of bladder function in 90% of patients directly after surgery and in 97% of them in the first two weeks. The recurrence rate in a median follow-up time of 18 months was 9.5%. The nerve-sparing radical hysterectomy approach, which depends on the comprehensive understanding of the precise entire anatomy of paracolpium is feasible and applicable even in locally advanced tumors, with good functional results and convincing short-term oncologic outcomes.