Radical prostatectomy: making it a better operation in the new millennium

Radical prostatectomy provides the best hope for long-term survival, free of disease, for organ-confined adenocarcinoma of the prostate. The operation is performed successfully only by understanding the remarkable anatomic variability of the prostate apex and the cylindrical nature of the striated urethral sphincter. When surgical techniques are used that take into account variations at the apex, with preservation of (i) neurovascular structures; (ii) the sphincteric urethra; and (iii) the adjacent levator ani, patients can look forward to a cure and the rapid return of urinary control and erectile function.