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Radical perineal prostatectomy - the contemporary resurgence of a genuinely minimally invasive procedure: Procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ-confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy.

Wroński S - Cent European J Urol (2012)

Bottom Line: This manuscript presents the technique of RPP used in the author's institution.RPP proves to be a very efficacious, cost-effective treatment option for localized PCa.The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, J. Biziel Memorial University Hospital, Bydgoszcz, Poland.

ABSTRACT

Introduction: Surgery plays a central role in the management of organ-confined prostate cancer (PCa). Four types of prostatectomy are currently practiced: perineal, retropubic, laparoscopic, and robot-assisted. The qualification criteria for all types are similar. Radical perineal prostatectomy (RPP) was the first method introduced into clinical practice, however, it has been neglected in favor of other procedures. Its resurgence has been facilitated by a multitude of advantages. Unfortunately, nowadays most urologists are not familiar with the perineal approach though many centers have begun to implement it.

Materials and methods: This manuscript presents the technique of RPP used in the author's institution. It also reviews a vast body of literature on the four techniques of prostatectomy including their advantages and outcomes. The data was collected from the literature and medical databases.

Conclusion: RPP proves to be a very efficacious, cost-effective treatment option for localized PCa. The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods.

No MeSH data available.


Related in: MedlinePlus

For nerve-sparing purposes, Denonvillier's fascia has been incised in the midline and separated together with the neurovascular bundles.
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Figure 0003: For nerve-sparing purposes, Denonvillier's fascia has been incised in the midline and separated together with the neurovascular bundles.

Mentions: Secondly, for nerve-sparing purposes, Denonvillier's fascia should be incised midline and separated together with the neurovascular bundles (Fig. 3). Otherwise the fascia is widely incised along the prostate contour together with the adjacent fibro-fatty tissue. The prostatic pedicles identified laterally to the seminal vesicles are dissected. The seminal vesicles are mobilized. The prostate remains attached only to the urethra and bladder neck. The dorsal veins and pubo-prostatic ligaments are bluntly separated from the apex. The urethra might be easily separated from the apex up to the intraprostatic segment to preserve striated sphincter and make the urethral stump as long as possible, but surgical margins should not be violated (Fig. 4). The urethra is dissected and four to five sutures (4-0/5-0 monofilament) are placed at the stump. The posterolateral surfaces of the prostate are bluntly separated from the bladder base and neck up to the proximal urethra, which can be preserved for urethro-urethral anastomosis. The prostate with seminal vesicles is resected (Fig. 5). A rectal inspection is recommended to reveal any unintentional lacerations.


Radical perineal prostatectomy - the contemporary resurgence of a genuinely minimally invasive procedure: Procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ-confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy.

Wroński S - Cent European J Urol (2012)

For nerve-sparing purposes, Denonvillier's fascia has been incised in the midline and separated together with the neurovascular bundles.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921814&req=5

Figure 0003: For nerve-sparing purposes, Denonvillier's fascia has been incised in the midline and separated together with the neurovascular bundles.
Mentions: Secondly, for nerve-sparing purposes, Denonvillier's fascia should be incised midline and separated together with the neurovascular bundles (Fig. 3). Otherwise the fascia is widely incised along the prostate contour together with the adjacent fibro-fatty tissue. The prostatic pedicles identified laterally to the seminal vesicles are dissected. The seminal vesicles are mobilized. The prostate remains attached only to the urethra and bladder neck. The dorsal veins and pubo-prostatic ligaments are bluntly separated from the apex. The urethra might be easily separated from the apex up to the intraprostatic segment to preserve striated sphincter and make the urethral stump as long as possible, but surgical margins should not be violated (Fig. 4). The urethra is dissected and four to five sutures (4-0/5-0 monofilament) are placed at the stump. The posterolateral surfaces of the prostate are bluntly separated from the bladder base and neck up to the proximal urethra, which can be preserved for urethro-urethral anastomosis. The prostate with seminal vesicles is resected (Fig. 5). A rectal inspection is recommended to reveal any unintentional lacerations.

Bottom Line: This manuscript presents the technique of RPP used in the author's institution.RPP proves to be a very efficacious, cost-effective treatment option for localized PCa.The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, J. Biziel Memorial University Hospital, Bydgoszcz, Poland.

ABSTRACT

Introduction: Surgery plays a central role in the management of organ-confined prostate cancer (PCa). Four types of prostatectomy are currently practiced: perineal, retropubic, laparoscopic, and robot-assisted. The qualification criteria for all types are similar. Radical perineal prostatectomy (RPP) was the first method introduced into clinical practice, however, it has been neglected in favor of other procedures. Its resurgence has been facilitated by a multitude of advantages. Unfortunately, nowadays most urologists are not familiar with the perineal approach though many centers have begun to implement it.

Materials and methods: This manuscript presents the technique of RPP used in the author's institution. It also reviews a vast body of literature on the four techniques of prostatectomy including their advantages and outcomes. The data was collected from the literature and medical databases.

Conclusion: RPP proves to be a very efficacious, cost-effective treatment option for localized PCa. The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods.

No MeSH data available.


Related in: MedlinePlus