Nerve-Sparing Open Radical Retropubic Prostatectomy Thomas M. Kessler, Fiona C. Burkhard, Urs E. Studer  European Urology  Volume 51, Issue 1, Pages 90-97 (January 2007) DOI: 10.1016/j.eururo.2006.10.013 Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 1 Innervation of the pelvic organs in the male. The arrow indicates the line of dissection when performing nerve-sparing open radical retropubic prostatectomy. Reproduced with permission from Kessler et al. Urol Clin North Am 2005;32:165–75. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 2 (A) Sharp dissection of the endopelvic and periprostatic fascia off the lateral wall of the prostate. (B) Separation of the neurovascular bundle from the lateral wall of the prostate. Reproduced with permission from Burkhard et al. [8]. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 3 Bunching of Santorini’s plexus including the ventral portion of the endopelvic and the periprostatic fascia with the curved Babcock clamp over the prostatic apex. Ligation over the apex of the prostate and at the bladder neck. Reproduced with permission from Burkhard et al. [8]. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 4 Transection of Santorini’s plexus above the prostate and not above the urethral sphincter. Preparation of the donut-shaped prostatic apex along the prostatic capsule. Reproduced with permission from Burkhard et al. [8]. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 5 Anastomosis between the urethra and the bladder neck with the sutures placed at the edge of the mucosa (A and B) to ensure a direct mucosa to mucosa anastomosis (C) without eversion of the bladder mucosa (D). Reproduced with permission from Burkhard et al. [8]. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 6 For construction of the anastomosis dorsal sutures are placed through the remnant of Denonvillier’s fascia and the urethral stump medial to the neurovascular bundles to avoid damage and ventral through ligated Santorini’s plexus to avoid traction on the sphincter muscle. Reproduced with permission from Kessler et al. Urol Clin North Am 2005;32:165–75. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 7 Proportion of continent and incontinent patients in relation to attempted nerve-sparing open radical retropubic prostatectomy. The overall continence rate was 94%. With bilateral or unilateral attempted nerve sparing or without attempted nerve sparing, continence rates were 99%, 97%, and 86%, respectively. The majority of the incontinent patients and all patients with stress incontinence grade II had no attempted nerve sparing. Reproduced with permission from Burkhard et al. [8]. European Urology 2007 51, 90-97DOI: (10.1016/j.eururo.2006.10.013) Copyright © 2006 European Association of Urology Terms and Conditions