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J Urol. 1998 Apr;159(4):1281-5.

Surgical modifications of radical retropubic prostatectomy to decrease incidence of positive surgical margins.

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1
Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA.

Abstract

PURPOSE:

We sought to determine whether recent surgical modifications in the technique of radical retropubic prostatectomy decrease the incidence of positive surgical margins.

MATERIALS AND METHODS:

We reviewed the records of 144 consecutive patients a mean of 60.8 years old who underwent radical retropubic prostatectomy using a modified surgical technique. Mean prostate specific antigen was 8.6 ng./ml. and mean Gleason grade was 5.8. Surgical modifications included division of the dorsal venous complex of the penis 10 to 15 mm. distal to the prostatic apex; transection of the urethra 3 mm. beyond the prostatic apex; division of the anterior aspect of the urethra, leaving the investing periurethral musculature intact, and division of the posterior aspect of the urethra en bloc with the striated urethral sphincter; sharp dissection of the rectourethralis muscle and remaining attachments of the prostate to the rectum; wide excision of the neurovascular bundle posterolateral to the prostate when adjacent induration or tumor is present, and division of the bladder neck, leaving a 5 mm. cuff of bladder tissue with the prostate.

RESULTS:

Of 144 consecutive patients 16 (11.1%) had positive surgical margins at a total of 20 sites, including 7 (35%) at the apex, 8 (40%) posterolateral, 3 (15%) anterior and 2 (10%) at the bladder neck. These results compare favorably with the positive surgical margin rates after radical prostatectomy previously reported in the literature.

CONCLUSIONS:

These surgical modifications appear to have decreased the incidence of positive surgical margins after radical retropubic prostatectomy.

PMID:
9507853
[Indexed for MEDLINE]
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