Chapter 31 - Radical Prostatectomy: The Retropublic Antegrade Approach

Abstract

Prostate cancer is the most common solid tumor in men. Patients diagnosed with a clinically localized prostate cancer have a variety of management choices, including radical prostatectomy, brachytherapy, external beam radiation therapy as well as conservative management such as watchful waiting. Radical retropubic prostatectomy remains the time-honored therapy for locally confined prostate cancer. Radical prostatectomy is considered to be a curative treatment. The advantages of retropubic radical prostatectomy are a lower rate of positive surgical margins, more consistent preservation of neurovascular bundles, and fewer rectal injuries. In addition, a staging pelvic lymphadenectomy can be done in the same session. Technical refinements in radical retropubic prostatectomy have resulted in lower rates of urinary incontinence and erectile dysfunction, less blood loss and shorter hospital stays, and lower rates of positive surgical margins. Complications of the radical prostatectomy can be grouped as intraoperative complications, early postoperative complications, and late postoperative complications. Hemorrhage is the most common intraoperative complication during radical prostatectomy. Incontinence, impotence, and bladder neck contracture are the late postoperative complications.