Anatomic basis for the continence-preserving radical retropubic prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Pelvic Anatomy

Background:

• Radical retropubic prostatectomy is a common treatment for prostate cancer.
• Urinary incontinence is a significant postoperative complication.
• Preservation of the external striated urethral sphincteric complex is crucial for continence.

Purpose of the Study:

• To describe the technique of continence-preserving anatomic radical retropubic prostatectomy.
• To highlight the critical anatomic components preserved during this procedure.
• To evaluate the impact of this technique on the time to achieve urinary continence.

Main Methods:

• Focuses on meticulous preservation of the rhabdosphincter musculature.
• Includes safeguarding periurethral fascial investments (pubourethral ligaments, median fibrous raphe).
• Emphasizes maintaining somatic and autonomic innervation to the urethral sphincter complex.

Main Results:

• The described technique successfully preserves the entire external striated urethral sphincter.
• Innervation pathways, including the pudendal nerve and inferior hypogastric plexus, are maintained.
• Patients undergoing this procedure experience a shorter time to achieve urinary continence.

Conclusions:

• Continence-preserving anatomic radical retropubic prostatectomy is an effective surgical approach.
• Preservation of the external urethral sphincter complex and its innervation is key to rapid continence recovery.
• This technique offers improved functional outcomes for patients undergoing prostatectomy.