Abstract
The technique of continence-preserving anatomic radical retropubic prostatectomy focuses on the preservation of the anatomic components of the external striated urethral sphincteric (EUS) complex. Three steps comprise this procedure for improving urinary control: 1) preservation of the anterolateral fascial attachments of the EUS, 2) protection of the innervation and the posterior fascial attachments of the EUS, and 3) avoidance of urethrovesical anastomotic sutures at the 5 and 7 oćlock positions. Preserving the external striated urethral sphincter and its innervation by performing a continence-preserving anatomic retropubic prostatectomy fascilitates a shorter time period for achieving urinary continence.
Similar content being viewed by others
References and Recommended Reading
Hollabaugh RS Jr, Dmochowski RR, Kneib TG, Steiner MS: Preservation of putative continence nerves during radical retropubic prostatectomy leads to more rapid return of urinary continence. Urology 1998, 5:960–967.
Walsh PC: Radical retropubic prostatectomy. In Campbell’s Urology. Edited by Walsh PC, Gittes RF, Perlmutter AD, Stamey TA. Philadelphia: WB.Saunders; 1986:2754–2775.
Walsh PC: Technique of radical retropubic prostatectomy with preservation of sexual function: an anatomic approach. In Diagnosis and Management of Genitourinary Cancer. Edited by Skinner DG, Lieskovsky G. Philadelphia: WB Saunders; 1988:753–778.
Walsh PC, Quinlan DM, Morton RA, Steiner MS: Radical retropubic prostatectomy: improved anastomosis and urinary continence. Urol Clin North Am 1990, 17:679–684.
Walsh P: Anatomic radical retropubic prostatectomy: an update after 2,000 cases. In Campbell’s Urology, Update 21. Edited by Walsh PC, Retik AB, Stamey TA, et al. Philadelphia: W.B.Saunders; 1997:1–14.
Walsh PC: Anatomic radical retropubic prostatectomy. In Campbell’s Urology, Update 21. Edited by Walsh PC, Retik AB, Stamey TA, et al.: Philadelphia: WB Saunders; 1997:2565–2588.
Myers RP: Male urethral sphincteric anatomy and radical prostatectomy. Urol Clin North Am 1991, 18:211–227.
Myers RP, Goellner JR, Cahill DR: Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection. J Urol 1987, 138:543–550.
Kaye KW, Milne N, Creed K, van der Werf B: The ‘urogenital diaphragm’, external urethral sphincter and radical prostatectomy. Aust N Z J Surg 1997, 67:40–44.
Kaye KW, Creed KE, Wilson GJ, et al.: Urinary continence after radical retropubic prostatectomy: analysis and synthesis of contributing factors: a unified concept. Br J Urol 1997, 80:444–501.
Hollabaugh RS Jr, Dmochowski RR, Steiner MS: Neuroanatomy of the male rhabdosphincter. Urology 1997, 49:426–434.
Eastham JA, Kattan MW, Rogers E, et al.: Risk factors for urinary incontinence after radical prostatectomy. J Urol 1996, 156:1707–1713.
Burnett AL, Mostwin JL: In situ anatomical study of the male urethral sphincteric complex: relevance to continence preservation following major pelvic surgery. J Urol 1998, 160:1301–1306. Report on an excellent study of the male urethral sphincteric complex that helps to unify many of the concepts of structural and functional anatomy.
Gosling JA, Dixon JS: The structure and innervation of smooth muscle in the wall of the bladder neck and proximal urethra. Br J Urol 1975, 47:549–558.
Gosling J: The structure of the bladder and urethra in relation to function. Urol Clin North Am 1979, 6:31–38.
Gosling JA, Dixon JS, Critchley HO, Thompson SA: A comparative study of the human external sphincter and periurethral levator ani muscles. Br J Urol 1981, 53:35–41.
McNeal JE: The prostate and prostatic urethra: a morphologic synthesis. J Urol 1972, 107:1008–1016.
Turner-Warwick R: The sphincter mechanisms: their relation to prostatic enlargement and its treatment. In Benign Prostatic Hypertrophy. Edited by Hinman JF. New York: Springer-Verlag; 1983:809.
Lowe BA: Preservation of the anterior urethral ligamentous attachments in maintaining post-prostatectomy urinary continence: a comparative study. J Urol 1997, 158:2137–2141.
Steiner MS: The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study. Urology 1994, 44:530–534.
Manley CB Jr: The striated muscle of the prostate. J Urol 1966, 95:234–240.
Oelrich TM: The urethral sphincter muscle in the male. Am J Anat 1980, 158:229–246.
Villers A, McNeal JE, Freiha FS, et al.: Invasion of Denonvilliers’ fascia in radical prostatectomy specimens. J Urol 1993, 149:793–798.
Elbadawi A, Mathews R, Light JK, Wheeler TM: Immunohistochemical and ultrastructural study of rhabdosphincter component of the prostatic capsule. J Urol 1997, 158:1819–1828.
Schroder HD, Reske-Nielsen E: Fiber types in the striated urethral and anal sphincters. Acta Neuropathol 1983, 60:278–282.
Strasser H, Frauscher F, Helweg G, et al.: Transurethral ultrasound: evaluation of anatomy and function of the rhabdosphincter of the male urethra. J Urol 1998, 159:100–105.
Hinman JF, Miller GM, Nickel E, Miller ER: Vesical physiology demonstrated by cineradiography and serial roentgenography. Radiology 1954, 62:713.
Juenemann KP, Lue TF, Schmidt RA, Tanagho EA: Clinical significance of sacral and pudendal nerve anatomy. J Urol 1988, 139:74–80.
Juenemann KP, Schmidt RA, Melchior H, Tanagho EA: Neuroanatomy and clinical significance of the external urethral sphincter. Urol Int 1987, 42:132–136.
Matzel KE, Schmidt RA, Tanagho EA: Neuroanatomy of the striated muscular anal continence mechanism. Implications for the use of neurostimulation. Dis Colon Rectum 1990, 33:666–673.
Strasser H, Klima G, Poisel S, et al.: Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate 1996, 28:24–31.
Bosch RJ, Benard F, Aboseif SR, et al.: Perineal pudendal neurotomy versus selective neurotomy of the S2 somatic contribution to the pudendal nerve: effects on sacral-root-stimulated bladder and urethral responses in the dog. Urol Int 1992, 48:48–52.
Zvara P, Carrier S, Kour NW, Tanagho EA: The detailed neuroanatomy of the human striated urethral sphincter [see comments]. Br J Urol 1994, 74:182–187.
Creed KE, Van Der Werf BA, Kaye KW: Innervation of the striated muscle of the membranous urethra of the male dog. J Urol 1998, 159:1712–1716. Report of a superb anatomical study that using classic neuropharmacology and structural anatomy to find the true innervation of the EUS.
Krahn HP, Morales PA: The effect of pudendal nerve anesthesia on urinary continence after prostatectomy. J Urol 1965, 94:282–285.
Lewis RW, Kim JCS, Irani D, Roberts JA: The prostate of the nonhuman primate: normal anatomy and pathology. Prostate 1981, 2:51–70.
Lapides J, Gray HO, Rawling JC: Function of striated muscles in control of urination: 1) effect of pudendal block. Surg Forum 1955, 6:611.
Lapides J, Sweet RB, Lewis LW: Role of striated muscle in urination. J Urol 1957, 77:247.
Liu S, Christmas TJ, Nagendran K, Kirby RS: Sphincter electromyography in patients after radical prostatectomy and cystoprostatectomy. Br J Urol 1992, 69:397–403.
Lepor H, Gregerman M, Crosby R, et al.: Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol 1985, 133:207–212.
Shafik A, el-Sherif M, Youssef A, Olfat ES: Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995, 8:110–115.
Ficazzola MA, Nitti VW: The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol 1998, 160:1317–1320.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Steiner, M.S. Continence-preserving anatomic radical retropubic prostatectomy: The “no-touch” technique. Curr Urol Rep 1, 20–27 (2000). https://doi.org/10.1007/s11934-000-0031-3
Issue Date:
DOI: https://doi.org/10.1007/s11934-000-0031-3