Blunt apical dissection during anatomic radical retropubic prostatectomy

We describe a novel technique using careful blunt dissection to better delineate the apex of the prostate, providing a simple means to potentially lessen positive surgical margins at the apex and promote better continence and erectile function in men undergoing an anatomic radical prostatectomy.Median operative time and blood loss were 190 minutes and 675 mL, respectively. Only 10 percent of the patients with positive surgical margins were found to have apical positive surgical margins. Ninety-three percent of patients reported no urinary leakage.We believe our technique of isolating the DVC with blunt dissection and then ligating and transecting the DVC to be feasible approach that requires larger studies to truly confirm its utility.In the US, radical prostatectomy (RP) is the most common treatment for localized prostate cancer [1] and results in durable, disease-free survival with few complications [2,3]. The durable disease-free survival and low complication rates are in part due to the meticulous apical dissection of the prostate which translates into less blood loss and improved visualization of critical structures [4]. Optimal visualization leads to reduction in positive apical surgical margin rates as well as improvement in the dissection of the urethra and caveronosal nerves which are critical when addressing post-prostatectomy continence and erectile dysfunction, respectively. This concept has been clearly illustrated previously by Walsh and Donker, who reported using sharp dissection to create a plane between the dorsal venous complex (DVC) and urethra [4,5]. Inappropriate sharp dissection can cause bleeding and may inadvertently injure the rhabdosphincter. A natural plane exists between the DVC and urethra that can be identified through careful blunt dissection. Herein, we report an effective method to optimally dissect the apex of the prostate and to assist in identifying and ligating the DVC.Patients underwent an anatomic radical retropubic prostatecto