Anatomic radical prostatectomy: Evolution of the surgical technique

Purpose: Although radical prostatectomy provided excellent cancer control, it never gained widespread popularity because of the major side effects of incontinence, impotence and excessive blood loss. The reason for this morbidity was a deficit in the understanding of the periprostatic anatomy. The evolution of the surgical technique for anatomic radical prostatectomy is described. Materials and Methods: Beginning in 1974 anatomic observations in the operating room were used to clarify the anatomy of the dorsal vein complex, pelvic plexus, striated urethral sphincter and lateral pelvic fascia. These intraoperative observations were amplified using dissections in stillborns and step section whole mount adult cadaveric studies. Results: Armed with improved information about the periprostatic anatomy, an anatomical approach to radical prostatectomy was developed. This surgical technique has improved surgical exposure, lowered blood loss, reduced urinary incontinence, made it possible to preserve potency and provided excellent cancer control. Conclusions: With the reduction in morbidity, radical prostatectomy today is an ideal treatment for the cure of prostate cancer in a patient who is curable and who is going to live long enough to need to be cured. Also the widespread application of radical prostatectomy has provided tissue and valuable pathological information that has galvanized research in the field.