AUA 2017: Radical Perineal Prostatectomy
Dr. Harris starts each case by placing an O’Connor drape over the patient, allowing digital access to the rectum throughout the case, which he notes is important for preventing rectal injuries during the posterior dissection. Next, he makes an inverted U incision and carries the dissection down to the level of Denonvillier’s fascia and subsequently to the level of the apex of the prostate. Following this, a key maneuver in Dr. Harris’ opinion is to place a Thompson retractor to allow for adequate exposure, particularly when one does not have a surgical assistant. He then commences dissection of the vas deferens and seminal vesicles until these are completely free, followed by entering the endopelvic fascia and carefully performing the nerve sparing portion of the procedure. Next he dissects he ties off and divides the dorsal venous complex, followed by ligating the prostatic pedicles bilaterally, and dividing the anterior urethra at the level of the verumontanum. Dr. Harris notes that it is important to divide the anterior urethra prior to the bladder neck so that visualization is not compromised for the bladder neck dissection. After bladder neck dissection the prostate is free and he is able to perform the urethrovesical anastomosis with a running 3-O monocryl suture.
Dr. Harris states that the majority of his patients undergoing radical perineal prostatectomy do not require pain medication after leaving the post-anesthesia care unit, are up walking later that evening, and discharged home on post-operative day #1. During the Q&A session with Dr. Dasgupta at the end of the session, Dr. Harris notes that when lymphadenectomy is necessary, this can be performed “laparoscopically in ~45 minutes of operative time.”
Presenter: Michael J. Harris, OSF St. Francis Hospital, Escanaba, MI, USA
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA