Maneuver to improve exposure during radical perineal prostatectomy.

OBJECTIVES

Radical perineal prostatectomy (RPP) has an important place as a management option for prostate cancer. Herein we describe an adaptation that we found to significantly help the exposure during this procedure.

METHODS

After opening the urethra, the long Lowsley tractor is changed to the short tractor. Caudal traction facilitates the dissection up to the bladder neck, which is opened. Classically, at this point an umbilical tape or Penrose drain substitutes the short tractor. Because of the limitation in the amount of traction that can be applied without fracturing through the tissue, we have utilized traction sutures placed in both right and left lobes of the prostate instead of the Penrose drain.

RESULTS

Traction on these sutures resulted in excellent exposure and greatly facilitated the posterior dissection of the prostate as well as seminal vesicles dissection.

CONCLUSIONS

This small addition to the standard technique of RPP helps with complete dissection of the prostate and seminal vesicles. We recommend replacing the traditional Penrose traction with these sutures placed in the lateral lobes of the prostate.