Radical transpubic prostatectomy

Removal of an adequate wedge of symphysis pubis provides considerably improved exposure for radical prostatectomy. It is safer to remove the symphysis subperiosteally and to transect the bone with an oscillating bone saw or osteotome. The transpubic approach to radical prostatectomy affords the urologist the advantages of 1) early direct ligation of the dorsal vein, 2) reduced incidence of injury to the external urethral sphincter and subsequent urinary incontinence owing to visualization of the urogenital diaphragm, 3) simplified urethrovesical anastomosis and 4) increased opportunity for maintenance of potency by protecting the pelvic nerve plexus as they course in the lateral vascular pedicles.