Radical prostatectomy: Anterior approach

Abstract

The anterior approach both for open and laparoscopic surgery is the one best known among urologists. The prostate is approached from above after lowering the bladder. The bladder neck is then sectioned to reach the ampulla and seminal glands. These preparatory steps are well described in the curriculum prepared and presented by the EAU/ERUS to teach robotic prostatectomies. The anterior approach is accomplished by a single incision of the peritoneum which also allows for an extensive lymphadenectomy if indicated. With the required expertise this approach also allows for correction of inguinal hernias whether discovered intraoperatively or known beforehand. The technique consisting of first approaching the bloc of ampulla and seminal glands (see chapter on the posterior approach) should also be known by urologist in specific situations, for example T3 tumours or after radiotherapy, in order to be sure of the feasibility of the prostate-rectal cleavage.