Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence
Objective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
PAGEPress Publications
2014-06-01
|
| Series: | Archivio Italiano di Urologia e Andrologia |
| Subjects: | |
| Online Access: | http://www.pagepressjournals.org/index.php/aiua/article/view/4550 |
| _version_ | 1818271695652257792 |
|---|---|
| author | Eugenio Brunocilla Riccardo Schiavina Marco Borghesi Cristian Pultrone Matteo Cevenini Valerio Vagnoni Giuseppe Martorana |
| author_facet | Eugenio Brunocilla Riccardo Schiavina Marco Borghesi Cristian Pultrone Matteo Cevenini Valerio Vagnoni Giuseppe Martorana |
| author_sort | Eugenio Brunocilla |
| collection | DOAJ |
| description | Objective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally oriented smooth muscle component of the urethral musculature that extends distally to the verumontanum. These two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring shaped vesical sphincter is separated from the prostate and the longitudinally oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Results: After 30 initial set-up procedures, 40 consecutive patients with organ confined prostate cancer were submitted to radical retropubic prostatectomy with the preservation of muscular internal sphincter and the proximal urethra and compared to 40 patients submitted to standard procedure who served as control group. The group of patients submitted to our technical modification had a faster recovery of early continence than control group at 3 and 7 days. Conclusions: The described technique is a feasible and safe method for preservation of the internal urethral sphincter and allows improving the early recovery of urinary continence. The technique does not increase the rate of positive margins and the duration of the procedure. |
| first_indexed | 2024-12-12T21:30:16Z |
| format | Article |
| id | doaj.art-21f576947f794740a44221f21c54268b |
| institution | Directory Open Access Journal |
| issn | 1124-3562 2282-4197 |
| language | English |
| last_indexed | 2024-12-12T21:30:16Z |
| publishDate | 2014-06-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Archivio Italiano di Urologia e Andrologia |
| spelling | doaj.art-21f576947f794740a44221f21c54268b2022-12-22T00:11:21ZengPAGEPress PublicationsArchivio Italiano di Urologia e Andrologia1124-35622282-41972014-06-0186213213410.4081/aiua.2014.2.1323746Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continenceEugenio Brunocilla0Riccardo Schiavina1Marco Borghesi2Cristian Pultrone3Matteo Cevenini4Valerio Vagnoni5Giuseppe Martorana6University of Bologna - S. Orsola-Malpighi Hospital, BolognaUniversity of Bologna - S. Orsola-Malpighi Hospital, BolognaUniversity of Bologna - S. Orsola-Malpighi Hospital, BolognaUniversity of Bologna - S. Orsola-Malpighi Hospital, BolognaUniversity of Bologna - S. Orsola-Malpighi Hospital, BolognaUniversity of Bologna - S. Orsola-Malpighi Hospital, BolognaUniversity of Bologna - S. Orsola-Malpighi Hospital, BolognaObjective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally oriented smooth muscle component of the urethral musculature that extends distally to the verumontanum. These two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring shaped vesical sphincter is separated from the prostate and the longitudinally oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Results: After 30 initial set-up procedures, 40 consecutive patients with organ confined prostate cancer were submitted to radical retropubic prostatectomy with the preservation of muscular internal sphincter and the proximal urethra and compared to 40 patients submitted to standard procedure who served as control group. The group of patients submitted to our technical modification had a faster recovery of early continence than control group at 3 and 7 days. Conclusions: The described technique is a feasible and safe method for preservation of the internal urethral sphincter and allows improving the early recovery of urinary continence. The technique does not increase the rate of positive margins and the duration of the procedure.http://www.pagepressjournals.org/index.php/aiua/article/view/4550Radical prostatectomyUrinary continenceInternal sphincterProximal urethraSurgical margins |
| spellingShingle | Eugenio Brunocilla Riccardo Schiavina Marco Borghesi Cristian Pultrone Matteo Cevenini Valerio Vagnoni Giuseppe Martorana Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence Archivio Italiano di Urologia e Andrologia Radical prostatectomy Urinary continence Internal sphincter Proximal urethra Surgical margins |
| title | Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence |
| title_full | Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence |
| title_fullStr | Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence |
| title_full_unstemmed | Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence |
| title_short | Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence |
| title_sort | preservation of the smooth muscular internal vesical sphincter and of the proximal urethra during retropubic radical prostatectomy a technical modification to improve the early recovery of continence |
| topic | Radical prostatectomy Urinary continence Internal sphincter Proximal urethra Surgical margins |
| url | http://www.pagepressjournals.org/index.php/aiua/article/view/4550 |
| work_keys_str_mv | AT eugeniobrunocilla preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence AT riccardoschiavina preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence AT marcoborghesi preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence AT cristianpultrone preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence AT matteocevenini preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence AT valeriovagnoni preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence AT giuseppemartorana preservationofthesmoothmuscularinternalvesicalsphincterandoftheproximalurethraduringretropubicradicalprostatectomyatechnicalmodificationtoimprovetheearlyrecoveryofcontinence |