Radical Perineal vs. Retropubic
Prostatectomy: A Review of
Optimal Application and
Technical Considerations in the
Utilization of These Exposures

Pj, Walther

doi:10.1159/000474386

Cited by 21 publications

(11 citation statements)

References 17 publications

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“…In the 1970s, the retropubic approach became the preferred approach because it recognized the importance of lymph node dissection for cancer staging (Resnick, 1996). Radical perineal prostatectomy has gained a renewed interest (Walther, 1993;Resnick, 1996;Gillitzer and Thuroff, 2002) in recent years, following surgical advances in pelvic lymph node dissection via laparoscopic approaches (Schuessler et al, 1991;Kerbl et al, 1993). This approach has also been aided by recent protocols that accurately stratify risk in prostate cancer patients, i.e., serum prostatespecific antigen, clinical staging, and Gleason's tumor grading (Lassen and Kearse, 1995;Resnick, 1996).…”

Section: Introductionmentioning

confidence: 99%

Histotopographic study of the rectourethralis muscle

et al. 2005

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Radical perineal prostatectomy, relative to retropubic prostatectomy, has become an increasingly used surgical technique for prostate cancer, following advances in laparoscopic methods for pelvic lymph node dissection. Recent protocols of risk stratification may even obviate the need for lymph node dissection. Section of the rectourethralis muscle (RUM) is necessary for access to the retroprostatic space, however, during this procedure rectal injuries may be produced. In this work, we studied the topography and morphology of the RUM, which, despite its importance in perineal surgery, has not been univocally described in the literature. After in situ formalin fixation, the pelvic viscera were removed from 16 male cadavers (age: 54-72 years) and from 4 full-term infants (gestational age: 37-38 weeks). Serial macrosections of the bladder base, prostate gland, and lower rectum cut in horizontal (6 adults and 2 infants) and sagittal (6 adults and 2 infants) planes underwent histological (hematoxylin and eosin, azan-Mallory, and Weigert's staining) and immunohistochemical (anti-smooth muscle actin and anti-sarcomeric actin) study. The remaining 4 adult specimens were cut in horizontal and sagittal planes and plastinated using the epoxy resin E12 sheet procedure. RUM was identified in 10 of 12 (83%) adult specimens and in 4 of 4 (100%) infant specimens. In both sagittal and transverse sections, it showed a triangular-shaped configuration. In all cases, at the level of its posterior portion, fibers continuing with the longitudinal muscular layer of the rectum were visible. In the majority of adult and infant cases, attachment of muscle fibers into the anterior wall of the anal canal was also observed. Anteriorly, the mean (+/-SD) distance between the RUM and the membranous urethra was 5.3 (+/-1.25) mm in adults and 1.0 (+/-0.41) mm in infants. Location of RUM in the prerectal space and the absence of urethral attachment makes the original name of this muscle, "prerectal," by Henle, more correct. In 7 of 10 (70%) adult cases and in 1 of 4 (25%) infant cases, muscle fibers were densely packed along the lateral portions of the RUM, while in its central portion connective tissue was prevalent, with sparse numbers of smooth muscle fibers. Immunohistochemical staining showed that this muscle consists almost entirely of smooth fibers. In all the infant specimens, the RUM was clearly separated from the levator ani, while in 8 of 10 (80%) adult cases, striated fibers of the levator ani and smooth fibers of the RUM intermingled. These structural associations suggest a functional cooperation between the two muscles, particularly in determining the anorectal flexure.

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Section: Introductionmentioning

confidence: 99%

Histotopographic study of the rectourethralis muscle

et al. 2005

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“…The advantages and disadvantages of these two approaches have been widely discussed in the literature. [19][20][21][22][23] Retropubic access in general is more familiar to urologists, as neurovascular bundle identification and preservation can be more readily performed and fewer rectal injuries can occur. However, an abdominal incision necessitates a longer hospital stay and can cause ileus, increased postoperative pain, and decreased mobility, leading to an increased risk of deep venous thrombosis.…”

Section: Radical Prostatectomymentioning

confidence: 99%

The Treatment of Prostate Cancer. . An Overview of Current Options

Pirtskhalaishvili

Hrebinko²,

Nelson³

2001

Cancer Pract

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The availability of several therapeutic options for localized prostate cancer warrants careful consideration when planning treatment with curative intent. Patients need to be active participants in decision making, and they must be aware of the benefits and possible complications of the different types of treatment. Patients with advanced prostate cancer need to be aware that hormone treatment will provide temporization and palliation in the majority of cases. Hormone-resistant prostate cancer is refractory to most forms of conventional and experimental therapy.

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“…The advantages and disadvantages of each approach have been well documented and will be briefly summarized [33,34,[36][37][38]. The retropubic approach is advantageous because the retropubic anatomy is more familiar to the radical pelvic surgeon, neurovascular bundle preservation is more easily performed, few rectal injuries occur, and a staging pelvic lymphadenectomy can be performed through the same incision, if required.…”

Section: Radical Prostatectomymentioning

confidence: 99%

Treatment of prostate cancer: Watchful waiting, radical prostatectomy, and cryoablation

Drachenberg

2000

Semin. Surg. Oncol.

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Current advances in diagnostic modalities and screening has lead to diagnosis of prostate cancer at an earlier stage (the so-called "stage shift" phenomenon), making primary treatments of localized disease of extreme importance in management. Therapeutic modalities include conservative management, radical prostatectomy, external beam radiotherapy, and newer techniques such as cryoablation surgery and brachytherapy. This review will focus on the non-radiation, non-hormonal primary treatment of localized prostate cancer and discuss the popularity and success of "watchful waiting," radical surgery, and cryoablation along with their advantages and disadvantages. These treatments will be compared to the qualities of an ideal treatment, which include cost effectiveness, efficacy, convenience of administration, tolerance by patients, low morbidity and mortality, and minimal impact on quality of life.

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Radical Perineal vs. Retropubic Prostatectomy: A Review of Optimal Application and Technical Considerations in the Utilization of These Exposures

Cited by 21 publications

References 17 publications

Histotopographic study of the rectourethralis muscle

Histotopographic study of the rectourethralis muscle

The Treatment of Prostate Cancer. . An Overview of Current Options

Treatment of prostate cancer: Watchful waiting, radical prostatectomy, and cryoablation

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