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Diagnosis and Treatment of Genitourinary Malignancies pp 129–145Cite as

Beyond the nerve-sparing radical prostatectomy

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Part of the book series: Cancer Treatment and Research ((CTAR,volume 88))

Abstract

Radical prostatectomy remains the most effective long-term treatment for patients with localized adenocarcinoma of the prostate. In the past it did not gain widespread popularity because many urologists believed the operation was technically difficult and was associated with significant intraoperative hemorrhage and postoperative impotence and incontinence. Over the past 15 years, an anatomical approach to radical retropubic prostatectomy has been developed that has greatly reduced the morbidity and mortality of the procedure. Delineation of the anatomy of the dorsal vein complex in 1979 by Reiner and Walsh enabled the procedure to be performed in a relatively bloodless field [1]. In 1982, Walsh and Donker described the anatomic course of the pelvic nerve plexus that provides innervation to the corpora cavernosa [2] and determined that impotence after radical prostatectomy was caused by injury to this plexus during dissection of the prostate. With the knowledge of the anatomy of the neurovascular bundles to the prostate and corpora carvernosa of the penis, the urologic surgeon may either spare the bundles or excise them when a wider margin is required to remove all of the tumor. Increased emphasis on the preservation of the striated urethral sphincter with an accurate sutured vesicourethral anastamosis that includes mucosal coaptation has led to a reduction in postoperative incontinence and bladder neck contracture [3]. This anatomic approach to radical prostatectomy has led to decreased blood loss and incontinence and has allowed many men to regain erectile potency. Thus, radical prostatectomy has become more acceptable to both patients and physicians.

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Authors
  1. Robert C. Smith
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  2. Gary D. Steinberg
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  3. Charles B. Brendler
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Editors and Affiliations

  1. Department of Internal Medicine Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, 48109-0680, USA

    Kenneth J. Pienta

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Smith, R.C., Steinberg, G.D., Brendler, C.B. (1996). Beyond the nerve-sparing radical prostatectomy. In: Pienta, K.J. (eds) Diagnosis and Treatment of Genitourinary Malignancies. Cancer Treatment and Research, vol 88. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-6343-3_8

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