Complete Periprostatic Anatomy Preservation During Robot-Assisted Laparoscopic Radical Prostatectomy (RALP): The New Pubovesical Complex-Sparing Technique

Stepwise Description and Outcomes of Bladder Neck Sparing During Robot-Assisted Laparoscopic Radical Prostatectomy

“…Our 1, 3 and 5-year biochemical recurrence-free survival 3) Bladder neck sparing was associated with fewer urinary leak complications and shorter length of stay, consistent with existing RALP literature comparing urinary leak and/or length of stay in bladder neck sparing vs nonsparing cases. 9,26 The shorter anastomotic suture line associated with bladder neck sparing likely heals more quickly and is less susceptible to urine leak. The greater frequency of urine leaks and accompanying peritonitis, and higher surgical drain output observed with nonbladder neck sparing vs bladder neck sparing may contribute to the greater variation in length of stay.…”

Ligation-free technique for dorsal vascular complex control during laparoscopic radical prostatectomy: a single-center experience from China

“…In 2010, Anastasios D. Asimakopoulos [4] reported a lateral approach to do the radical prostatectomy for preservation of pubovesical complex. By doing this technique, the author declared that it leads toward the absolute preservation of the periprostatic anatomy which would enhance early functional outcomes.…”

“…After entering the retropubic space of Retzius using either a transperitoneal or extraperitoneal approach, the bladder neck was identified via a previously filled catheter balloon [4] and the bladder anterior and posterior walls were incised at the junction of the prostate and the bladder. The vas deferens was then cut to enable recognition and isolation of the seminal vesicle.…”

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

“…They described that a possible explanation of the limitation of puboprostatic ligament preservation could be that, because there was demonstrable anatomic continuity with the bladder, there were no conceivable means of preserving the pubovesical ligaments during RARP, and there must be interruption at some point to expose the pubourethral junction 30) . In this procedure, the prostate is shelled out from underneath the spared pubovesical complex and urethrovasical anastomosis is performed under the spared complex.…”

“…80% of patients were dry (0 pads), and 20% of patients needed one security pad at catheter removal. Absolute preservation of the periprostatic anatomy may enhance early functional outcomes 30) .…”