Management with Santorini's Plexus Should Be Personalized during Prostatectomy.

Area of Science:

• Urology
• Surgical Oncology

Background:

• The management of the Dorsal Venosus Complex (DVC) during radical prostatectomy remains a debated topic in urological surgery.
• Optimal surgical techniques aim to minimize blood loss and positive surgical margins while preserving functional outcomes.

Purpose of the Study:

• To compare the outcomes of laparoscopic prostatectomy with and without Dorsal Venosus Complex (DVC) ligation.
• To evaluate the impact of DVC management on blood loss, surgical duration, positive margin rates, and functional recovery.

Main Methods:

• A comparative study of 457 patients undergoing laparoscopic prostatectomy across two high-volume centers.
• One center routinely performed DVC ligation, while the other omitted this step.
• Histological and functional outcomes were assessed and compared between the two groups.

Main Results:

• DVC management significantly influenced intraoperative blood loss and surgical procedure duration.
• Omitting DVC ligation was associated with a reduced rate of positive surgical margins, particularly in cases of apical tumor localization.
• Urinary continence and erectile function showed no significant difference between the groups at 12-month follow-up.

Conclusions:

• The management strategy for the Dorsal Venosus Complex (DVC) affects key surgical parameters in laparoscopic prostatectomy.
• Omitting DVC ligation may be a beneficial approach for improving oncological control at the apex without compromising functional outcomes.
• Further research can refine DVC management protocols to optimize patient results.