Editing Open Radical Prostatectomy (section)

== Radical retropubic prostatectomy: surgical anatomy ==

* '''See Prostate Anatomy Chapter Notes'''
* During radical perineal prostatectomy, the endopelvic and anterior pelvic fasciae are reflected off the prostate in an effort to avoid injury to the dorsal vein of the penis and Santorini plexus. Therefore, '''the dorsal vein complex is not divided during perineal prostatectomy because the dissection occurs beneath the endopelvic fascia and anterior pelvic fascia.'''
* In performing '''radical retropubic prostatectomy''', the prostate is approached from outside these fascial investments. For this reason, the '''dorsal vein complex must be ligated''' and the lateral pelvic fascia must be divided
* '''Radical prostatectomy may compromise arterial supply to the penis.'''
** '''Although the major arterial supply to the corpora cavernosa is derived from the internal pudendal artery. pudendal arteries can arise from abberant branches the obturator (most commonly), inferior vesical, and superior vesical arteries. These aberrant branches travel along the lower part of the bladder and anterolateral surface of the prostate and are typically divided during radical prostatectomy.'''
* '''Pelvic plexus'''
** '''The branches of the inferior vesical artery and vein that supply the bladder and prostate perforate the pelvic plexus.'''
*** '''Division of the so-called lateral pedicles of the bladder and prostate proximally/in its midportion not only interrupts the vessels but also transects the nerve supply to the prostate, urethra, and corpora cavernosa with attendant postoperative impotence. Ligation is best carried out near the bladder to avoid nerve damage.'''
** The cavernous nerve branches join the capsular arteries and veins in a spraylike distribution to form the NVB 20 to 30 mm distal to the junction of the bladder and prostate. '''The NVBs are located between the prostatic and the endopelvic/levator fascia.'''
* '''Striated urethral sphincter'''
** In the adult, the fibers at the apex of the prostate are horseshoe shaped and form a tubular, striated sphincter surrounding the membranous urethra. Near the apex of the prostate, the edges fuse in the midline posteriorly
** '''Contains fatigue-resistant, slow-twitch fibers that are responsible for passive urinary control.'''
** '''The pudendal nerve provides the major nerve supply to the striated sphincter and levator ani.'''