Apical dissection during radical retropubic prostatectomy without ligature

Abstract

During radical retropubic prostatectomy, hemostasis of the venous vascular plexus is of the utmost importance for avoiding excessive blood loss and ensuring optimal preservation of urethral length, complete extirpation of all apical prostatic notches and careful preservation of the parasympathetic nerves ('neurovascular bundles'). We have developed a careful bipolar coagulation of the venous plexus that results in a significant reduction of intra-operative blood loss, and the consequent need for transfusion, compared to the standard approach. Furthermore, this coagulation approach results in improved visibility, allowing maximum preservation of urethral length, complete extirpation of all apical prostatic notches and improved application of the nerve sparing technique compared to the standard approach. Follow-up after a mean of 14 months suggests that postoperative continence and potency is at least comparable to the standard approach. However, long-term follow-up and multicenter studies will show if this modification results in equally effective cancer control and equivalent functional results compared to the standard approach.