Radical endoscopic assisted perineal prostatectomy.
OBJECTIVE
During radical perineal prostatectomy transection of the bladder neck and dissection of the seminal vesicles under direct vision can be difficult. We describe a technique of radical endoscopic assisted perineal prostatectomy that facilitates dissection of these structures.


METHODS
Cadaveric dissections were performed in 4 individuals to develop and assess the technique. It was subsequently applied to a 64-year-old male with clinically localized prostate cancer (Gleason grade 3+3). Management of the bladder neck and seminal vesicles was performed with a bipolar transurethral resectoscope. The remainder of the procedure was performed via a traditional subsphincteric perineal approach with the patient in the standard dorsal lithotomy position.


RESULTS
The bladder neck and seminal vesicles were successfully dissected in 55 minutes. Total operative time was 3 hours. Estimated blood loss was 500 cc. The patient was discharged home the morning of postoperative day 1 and the catheter was removed in the clinic on postoperative day 7. The final pathology report showed organ confined prostate cancer (Gleason 3+3).


CONCLUSIONS
Radical endoscopic assisted perineal prostatectomy allows precise dissection of the bladder neck and seminal vesicles under direct vision. Accomplishing this dissection as the initial step of the procedure mobilizes the prostate, facilitating excision, and obviates the need for the extreme lithotomy position.
Ellison
Lars M
LM
Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Pinto
Peter A
PA
Kavoussi
Louis R
LR
D004724:Endoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D012669:Seminal Vesicles / Q000601:surgery; D001743:Urinary Bladder