Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: Description of the technique

Abstract

Abbreviations & AcronymsAbstract: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy. The first steps of the prostatectomy reflect the standard retropubic prostatectomy; whereas for the final phases, the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally-oriented smooth muscle component of the urethra that extends distally to the verumontanum; these two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring-shaped vesical sphincter is separated from the prostate and the longitudinally-oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Finally, a urethra-urethral anastomosis is carried out and the ventral stitches are placed through the circular fibres of the bladder neck. In all cases we carry out circumferential biopsies of the proximal urethra and of the base of the prostate. The described technique is a feasible and safe method for preservation of the internal urethral sphincter. Despite the enthusiasm regarding our positive functional results, further studies with larger series are required to confirm these findings.

Description of the Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique

“…Therefore, the drainage volume was low, similar to the good results observed for length of hospital stay (mean of 3.4 days, range 3−5 days depending primarily on suction drain volume) and bladder catheterization. These improvements in recovery-related outcomes are benefits of the anterograde technique that have been previously reported for video-assisted surgery; however, the present study is the first to report consistent findings using the same surgical procedure with an open technique [11,13,[18][19][20][21]. In this series, the catheter was typically removed 1 week after surgery.…”

“…This study also observed earlier continence in the RARP group (25 days vs. 75 days in the RRP group) [17]. Several studies have attempted to develop better methods to preserve continence after radical prostatectomy, although there are no known factors capable of improving this outcome in RRP [6,18]. Postoperative continence appears to be multifactorial.…”

“…The enhanced vision associated with a convenient sitting position, wider operative field, and ability for more precise movements are advantages of robotic-assisted surgery, and are part of evolution in surgical techniques toward better visualization of pelvic anatomical structures such as the cavernous nerve fibers within the periprostatic tissue, seminal vesicles, prostatic pedicle, apex, and urethra [1,2,5,[15][16][17][18]. This advancement has allowed for the development of a new method to perform an anterograde anatomical dissection technique that is more precise and less invasive than the classical open RRP described in 1983 by Walsh et al [2,5,6,[9][10][11]15,17,18]. Our study demonstrates the feasibility of performing this surgery using an open technique, without adding the high costs of new technology.…”

First case of bilateral, synchronous anaplastic variant of spermatocytic seminoma treated with radical orchifunicolectomy as single approach: Case report and review of the literature

“…Spermatocytic Seminoma (SS) is a rare germ cell tumor, characterized by a benign behavior with slow growth, and is generally localized in the testis; this tumor has a good long term prognosis, and is always controlled by one of the simplest intervention in urology, such as radical orchiectomy with nearly absent risks of complications contrarily to many other urological interventions (15,16); in literature over 200 cases of SS have been described with only three cases of clearly established metastasis for the No conflict of interest declared conventional type of this tumor (8). It is universally accepted that the sarcomatous differentiation of SS is associated with an aggressive behavior, the presence of metastasis and a poor prognosis (12,13,17,18), despite aggressive surgical and adjuvant treatments (19).…”

Male Stress Urinary Incontinence Following Surgical Intervention: Procedures, Technical Modifications, and Patient Considerations

“…water) and increased functional urethral length (27.6 versus 20.5 mm) as compared to incontinent patients [ 79 ]. Brunocilla et al [ 80 ] describe their technique of preserving the smooth muscular internal sphincter and proximal urethra by an anterograde approach with incision of the detrusor muscle at the insertion of the ventral surface of the base of the prostate during open RRP. After identifi cation of the sphincteric ring, blunt dissection is performed to separate the sphincter from the prostate to obtain a maximal length of the internal sphincter before incising the urethra and performing a urethral-urethral anastomosis [ 80 ].…”