Open Radical Retropubic Prostatectomy

We describe a surgical procedure for radical retropubic prostatectomies that we have used in a prospective series of 231 patients with localised prostate cancer (mean age 63 yr; range: 46–75 yr). Nerve-sparing was performed in 148 of 231 patients. We insist on three points: (1) high-quality preservation of the sphincter, with the sphincter divided to keep its anatomic environment intact; (2) high-precision retrograde dissection of the neurovascular bundles in the mid-gland prostate zone for early recovery of erectile function (the dissection of the bundles is described for each prostate zone [apex, mid-gland, base]); and (3) the need to standardise each step of the procedure for a reproducible protocol independent of individual patient anatomy. These three measures will ensure the best cancer control with the best functional results. The rate of positive margins for patients with organ-confined (pT2) cancer was 3.7% (2.4% related to an invaded striated sphincter). The quality of the excised specimens was further checked by noting the frequency of capsular incision (2.6%) and of inked benign prostatic glands (2.6%). By 12 mo, 94% of patients were fully continent and 70.5% had recovered the ability to maintain an erection for satisfactory sexual intercourse without the need for medication.