Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex

Abstract

Aim: To describe our surgical technique for dissecting the apex of prostate during robotic-assisted laparoscopic radical prostatectomy (RALP) and detailed surgical anatomy of prostate including relationship between urethra and dorsal vein complex with apex. Materials and Methods: In retrospective view of prospective collected data, 73 patients underwent RALP between December 2012 and September 2014. Surgical anatomy of prostate was revealed in all procedures. Quality of life (QoL) scores were assessed before, immediately after catheter removal, and 1 month after surgery. We divided urinary continence into 3 groups, as very early continence; continence at time of urethral catheter removal, early continent; and continence 1 month after surgery. The rest of the patients were accepted as continence. Results: The mean follow-up was 10.2 ± 5.4 months and mean age was 61.5 ± 6.6. Maximum protection of urethra could be provided in all. Mean catheter removal was 8.9 ± 1.7 days, and all patients were continent at the time of catheter removal. QoL scores before RALP could be protected after surgery (p = 0.2). Neither conversion to open/conventional laparoscopic surgery nor complications related with bladder neck were detected. Conclusions: Our surgical technique can be a strong candidate for being a surgical technique for preserving urethra and very early continence could be provided after surgery.

Subsphincteric Anastomosis During Laparoscopic Robot-Assisted Radical Prostatectomy and Its Positive Impact on Continence Recovery

“…A significant enhancement of the continence rates was reported by Tunc with the improvement of the dissection and the preservation of the bladder neck and of the apex. 14,29 Argun and colleagues 15 was the first to report of a positive impact of stay sutures on early continence recovery (73% vs 35% p < 0.0001 at 1 month, and 83% vs 53% p = 0.0004% at 3 months), allowing more precision during placement of the urethral sutures and thereby avoiding retraction of the urethra and injury to the striated sphincter while suturing.…”

Application and Efficacy of Pubovesical Complex Preserving Technique During Laparoscopic Radical Prostatectomy

“…Therefore, more scholars have conducted in-depth anatomical studies to accurately dissect the nerves and blood vessels around the prostate and urethra [8,9]. PPLRP technology is an improvement based on the "The veil of Aphrodite technique" [10], which retains NVB extensively in robotic assisted radical prostatectomy (RARP).…”