Puboprostatic ligament sparing radical retropubic prostatectomy

Prostate cancer is the most common solid malignancy and the second most common cause of cancer death in man. Radical prostatectomy is the therapeutic modality that currently provides the best long-term biochemical relapse-free survival rate. Yet many patients select alternative forms of therapy or no therapy at all because of fears that treatment will significantly alter quality of life. Urinary incontinence following radical prostatectomy has a significant deleterious effect on quality of life and, unfortunately, is much more prevalent following surgery compared with other treatment modalities, such as radiation therapy. Many efforts have been undertaken to avoid this complication with only modest success achieved. These include creation of a neobladder neck, bladder neck preservation, periurethral injection of bulking agents, and anterior urethropexy. A technique for radical retropubic prostatectomy that spares the puboprostatic ligaments, which preserves the normal anterior support of the urethra, is described herein. The outcome following this procedure demonstrates more rapid return of full urinary continence following radical prostatectomy in a controlled study. However, the "Holy Grail" of complete eradication of urinary incontinence following radical prostatectomy has not been achieved.