Radical retropubic prostatectomy with reduced morbidity: an anatomic approach

The morbidity of radical retropubic prostatectomy for prostate cancer has been reduced through improved understanding of the surgical anatomy of the prostate. Delineation of the anatomy of the dorsal vein complex has led to modifications in the surgical technique that have reduced blood loss and improved surgical exposure. The addition of epidural anesthesia and presurgical donation of autologous blood has limited the need for the homologous transfusion of blood to 2% of the patients and has reduced the frequency of serious perioperative complications such as pulmonary emboli to 0.3%. Delineation of the anatomy of the pelvic plexus and identification of the neurovascular bundles as the macroscopic landmark of the microscopic cavernous nerves have made it possible for the surgeon to make an informed decision at the time of surgery whether the neurovascular bundles can be preserved safely or excised widely with the specimen. In all surgical approaches to prostate cancer, the primary goal must be excision of all tumor; preservation of sexual function should be of secondary concern. These considerations were addressed in the treatment of 320 consecutive patients; 74% of the men are potent postoperatively. It was necessary to excise one neurovascular bundle widely in 49 patients; 69% are potent. In addition to improvements in postoperative sexual function, the incidence of incontinence following surgery has been reduced. The total medical expenses for patients undergoing radical prostatectomy range from $8,500 to $9,500 and are similar to those for external-beam radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)