Volume 56, Issue 2, Pages 317-324 (August 2009) Current Technique of Open Intrafascial Nerve-Sparing Retropubic Prostatectomy  Lars Budäus, Hendrik Isbarn, Thorsten Schlomm, Hans Heinzer, Alexander Haese, Thomas Steuber, Georg Salomon, Hartwig Huland, Markus Graefen  European Urology  Volume 56, Issue 2, Pages 317-324 (August 2009) DOI: 10.1016/j.eururo.2009.05.044 Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 1 The dorsal vein complex adjacent to the prostate, starting on the higher half of the prostate at the 2 o’clock and the 10 o’clock positions. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 2 Only the endopelvic fascia and the membrane of the external sphincter are included within the oversewn distal part of the dorsal vein complex. Mueller's ligaments, with the adjacent neurovascular bundles below the 10 o’clock and the 2 o’clock positions, are marked with red arrows. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 3 Longitudinal section of the prostate; most of the fibres of the neurovascular bundles are running adjacent on the lateral and lower parts of the prostate, so the dissection should start high on the prostate. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 4 Preparation of the apex and sphincter, with the circular and longitudinal muscle fibres dissected very close to the apex of the prostate, ensuring a maximum length of functional tissue. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 5 Principle of anastomotic sutures. The sutures are placed through the everted bladder mucosa. Traction of the whole membranous urethra is reached by including the Denonvilliers’ fascia and the raphe of the sphincter muscle within the 6 o’clock suture. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 6 The (a) right side of the prostate (b) is inked green before removing the slice for frozen section analyses for intraoperative evaluation of the surgical margin. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 7 The (a) different sides of the slice for frozen section analyses (b) are inked in a different colour (towards the prostate and towards the neurovascular bundle green or blue and yellow towards the prostate). This technique enables the pathologist to differentiate between true- and false-positive surgical margins. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 8 Biochemical recurrence (BCR)–free survival; long-term follow-up of patients treated between 1992 and 1997 with retropubic prostatectomy according to the pathological T stage. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 9 Long-term cancer-specific-mortality (CSM)–free survival after retropubic prostatectomy according to the pathological T stage. European Urology 2009 56, 317-324DOI: (10.1016/j.eururo.2009.05.044) Copyright © 2009 European Association of Urology Terms and Conditions