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Volume 3, Issue 2, Pages (June 2005)

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1 Volume 3, Issue 2, Pages 77-85 (June 2005)
Indication, Technique and Outcome of Retropubic Nerve-Sparing Radical Prostatectomy  Markus Graefen, Uwe H.G. Michl, Hans Heinzer, Martin G. Friedrich, Christian Eichelberg, Alexander Haese, Hartwig Huland  EAU Update Series  Volume 3, Issue 2, Pages (June 2005) DOI: /j.euus Copyright © 2005 Elsevier B.V. Terms and Conditions

2 Fig. 1 Kaplan-Meier analyses of recurrence-free survival stratified to operative technique (nsRP vs. non-nsRP) and pathologic stage (n=1755). EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

3 Fig. 2 Number of radical prostatectomies (RRP), number of organ-confined cancers (pT2), and number of nerve-sparing procedures (NE) performed at the University Hospital Hamburg–Eppendorf between 1/1992 and 12/2004. EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

4 Picture 1 Open retropubic prostatectomy can be performed by 2 surgeons. We recommend the use of a self retaining retractor, loops, and head-light to guaranty optimal exposure of the prostate. EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

5 Picture 2 The dorsal vein complex runs between 2 membranes. The upper membrane is the continuation of the endopelvic fascia, whereas the lower membrane is the fascia of the striated external sphincter. EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

6 Picture 3 Distribution of nerve fibers at the dorso-lateral aspect of the prostate. This anatomical study underlines the importance of the incision of the parapelvic fascia high up on the dorsal area in order to preserve a maximum of nerve fibers. EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

7 Picture 4 (a–c) A small incision of the parapelvic fascia covering the prostate (a) it will be undermined using a small overholt (b). The fascia will then be clipped and divided (c) throughout the whole lateral aspect of the prostate. EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

8 Picture 5 (a and b) If extra-capsular extension is suspected a slice from the lateral surface of the prostate should be taken after the prostate is removed (a) and the area of the prostate capsule that was adjacent to the neuro-vascular bundle should be inked. In addition, the area from which the slice was taken should be inked in a different color for later differentiation of true surgical margin and margin of intraoperative frozen section (b). EAU Update Series 2005 3, 77-85DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions


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