Category: Robotic Surgery: New Techniques - Malignant

VS13-10 - Challenging Step and Technique of Robot-Assisted Radical Prostatectomy: Prostatic Apex Preservation

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

To describe our prostatic apex preservation technique during robot assisted radical prostatectomy (RALP) for protection of external sphincter and save long enough urethra for vesicourethral anastomosis.


Methods :

With the spread of robotic surgical techniques worldwide RALP has become the most comfortable surgical method in eligible prostate cancer patients. However, some important points that affect the success of the operation need to be clarified. Our technique for prostatic apex preservation is the most suitable technique for external sphincter protection and save long enough urethra for vesicourethral anastomosis.


Technique: Anterior dissection of the prostate is performed between the dorsal vein complex and prostatic fibromuscular stroma following the dorsal vein complex ligation. The anatomical space between DVC and prostate apex is filled by fat-rich connective tissue. With the dissection of this tissue by robotic closed scissor “U” shape space that the arms of  “U” created by prostate apex may have easily. After the prostatic apex has clearly been seen urethra can be cut from the apex border to obtain an appropriate length of urethra for vesicourethral anastomosis. The appearance of verrumontanum during the cutting of the urethra is evidence of correct dissection.


Results :

Our prostatic apex preservation technique by giving the appropriate length of urethra and protecting the sphincter shows better postoperative results than other techniques. The main advantages of this technique are very early continence rates and less bladder neck stenosis risk. 


Conclusions :

Prostatic apex dissection is one of the most important steps of the RALP procedure. It effects both functional and oncologic outcomes. With our prostatic apex preservation technique, reduced incontinence rates, bladder neck stenosis complication and negative surgical margin in pathological reports are provided.

Serdar Yalcin

Urologist
Ankara, Ankara, Turkey

Engin Kaya

Urologist
Ankara, Ankara, Turkey

Eymen Gazel

Urologist
acibadem
Ankara, Ankara, Turkey

Im working İn Acibaem University Ankara hospital as Asist.Prof in Ankara,Turkey

Halil Cagri Aybal

Urologist
Ankara, Ankara, Turkey

Tahsin Batuhan Aydogan

Urologist
Goksun, Kahramanmaras, Turkey

Mehmet Ezer

Mus, Mus, Turkey

Lutfi Tunc

Urologist
Gazi University School of Medicine Dept. of Urology
Ankara, Ankara, Turkey