Radical retropubic prostatectomy. Technical improvements and results.

Objective : The usual procedure in nerve-sparing radical retropubicprostatectomy is to perform a dissection right against the prostaticfascia. However, this carries the risk of leaving positive margins.Our aim was to develop a dissection procedure a few millimetersaway from the prostatic fascia that reduces this risk.Method : The neurovascular bundles run between the two layers ofthe lateral pelvic fascia (the levator and prostatic fascia). We firstincise the levator fascia at the posterolateral edge of the prostate.We then dissect the bundle leaving a thin wedge of connective tissuealong the prostatic fascia. This procedure isolates tiny vascularpedicles. The bundle must never be just released from the prostatebut dissected in a very small space, away from the prostate, withoutbeing injured. When the vascular pedicles are divided, 2 to 3 mm oftissue are systematically left along the prostatic fascia. This safetyzone of connective tissue should be visible on histological sections.Results : In our series of 605 consecutive radical prostatectomies,200 patients underwent nerve sparing surgery (173 bilaterally ; 27unilaterally). Positive margins were found at the nerve sparing sitein 8 patients (4%). Overall, 118 patients have been followed up fortwo years. Recovery of erections sufficient for intercourse occurredin 80/98 pre-operatively potent men (81,6%) who underwent bilat -eral nerve sparing surgery and 11/20 men (55%) who underwentunilateral surgery.Conclusions : Our technique carries a very limited risk of leavingpositive margins and yields results for return of sexual function thatare similar to those of traditional t echniques.