Radical Retropubic Prostatectomy

Abstract

Radical prostatectomy for the treatment of prostate cancer has evolved over the last 60 years with surgical removal of the entire prostate becoming a standard treatment for localized prostate cancer. Of the two standard open radical prostatectomy techniques, the perineal and retropubic, radical retropubic prostatectomy has become the most common approach. The retropubic procedure is often considered technically demanding primarily due to the location of the prostate deep within the male pelvis; it also can be considered the most anatomic approach. In addition to ensuring the removal of the cancer, the surgeon must negotiate the risk of blood loss, and avoid damage to surrounding structures while performing reconstruction to preserve continence and maintain potency if present. Although robotically assisted laparoscopic radical prostatectomy has become the most common surgical procedure for radical prostatectomy in the United States, the open radical prostatectomy remains an important procedure. There are patients who are not suitable candidates for a robotically assisted radical prostatectomy or for whom the more costly robotic technology may not be readily available. This chapter reviews the current application of open retropubic radical prostatectomy.