AVOIDING COMPLICATIONS OF RADICAL RETROPUBIC PROSTATECTOMY

During the past 15 years radical retropubic prostatectomy (RRP) has be come the treatment of choice for localized prostate cancer. Before the 1980s the procedure was characterized by a significant number of intr aoperative, postoperative and long-term complications. Since then the operation has evolved continuously, using the results from anatomical studies, and has resulted in a marked reduction in the morbidity and m ortality associated with this procedure. The modem, anatomical approac h to RRP emphasizes the principles of direct visualization and identif ication of the anatomical structures in the pelvis. Management of the dorsal vein complex and techniques for apical resection of the prostat e, combined with improved understanding of the pelvic floor anatomy, h ave contributed to a reduced frequency of postoperative incontinence. The identification and localization of the 'erectile nerves' (autonomi c branches of the pelvic plexus to the corpora cavernosa) in the neuro vascular bundles outside the prostatic capsule and Denonvilliers' fasc ia enables nerve-sparing surgery. In selected cases, sparing of the ne urovascular bundles is possible to preserve sexual function without co mpromising cancer control as the principal goal of RRP.