Improving the preservation of the urethral sphincter and neurovascular bundles during open radical retropubic prostatectomy.
OBJECTIVE
To describe a technique for open nerve-sparing radical retropubic prostatectomy.


METHODS
The technique basically implies incising the levator and prostatic fasciae high anteriorly (1 and 11 o'clock positions) over the prostate, developing the plane between the prostatic capsule and prostatic fascia, and displacing the neurovascular network localized between the two fasciae laterally. This allows for a minimal-touch dissection of the external urethral sphincter and a very efficient dissection of the neurovascular bundles at the level of membranous urethra and prostatic apex.


RESULTS
Forty-two patients underwent a bilateral nerve-sparing operation and were followed- up for 6 months. Six patients (14.3%) had positive margins: 4 patients had pT2 disease (in all, the positive margin was monofocal) and 2 patients had pT3 disease (both had multifocal positive margins). Continence (defined as being dry or having one pad remain dry for 24 hours) was achieved in 44% of patients at catheter removal, and in 60%, 72%, and 90% of patients at the 1-, 3-, and 6-month follow-up visits. Potency (defined as an erectile function domain score > or =26) was obtained in 15%, 40%, and 52% of patients at the 1-, 3-, and 6-month follow-up visits. All patients used a PDE5-inhibitor during the investigation period.


CONCLUSIONS
These preliminary results suggest that the high incision of the levator and prostatic fasciae may facilitate efficient preservation of the external urethral sphincter and the neurovascular bundles innervating the corpora cavernosa and the sphincter.
Montorsi
Francesco
F
Department of Urology, Universita' Vita Salute San Raffaele, Milan, Italy. montorsi.francesco@hsr.it
Salonia
Andrea
A
Suardi
Nazareno
N
Gallina
Andrea
A
Zanni
Giuseppe
G
Briganti
Alberto
A
Deho'
Federico
F
Naspro
Richard
R
Farina
Elena
E
Rigatti
Patrizio
P
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D007172:Erectile Dysfunction / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000502:physiology; D009367:Neoplasm Staging; D010413:Penis / Q000294:innervation; D011183:Postoperative Complications / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control*
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen