Retropubic radical prostatectomy: The technique

Abstract

Open retropubic radical prostatectomy remains the gold standard treatment for clinically localized prostate cancer (PCa), while other surgical treatment options such as laparoscopic and robotic radical prostatectomy have become available at many centers worldwide. The three goals of treatment of localized PCa, in order of importance, are cancer control, preservation of urinary control, and preservation of sexual function. In this chapter, we review our institutional experience with retropubic radical prostatectomy and illustrate the technical maneuvers of the surgical procedure. We provide a detailed description of the surgical technique and pre- and postoperative measures. The control of the dorsal venous complex (DVC) is emphasized as an important step to minimize blood loss and provide a bloodless surgical field. Although nerve-sparing procedures are routinely performed worldwide, both nonnerve-sparing and nerve-sparing procedures are described. Bladder neck preservation and bladder neck resection are both explained. We also highlight the impact of surgical training on the surgical quality and better functional results. In addition, we give an overview of the surgery-related complications and the surgical modifications to the standard operation to improve early return of urinary continence and erectile function.