Two-plane modified radical retropubic prostatectomy.

Salvage radical prostatectomy may be effective in patients refractory to radiation therapy. We describe a modified technique of radical retropubic prostatectomy, whereby a transverse incision in the cul-de-sac is made and the seminal vesicles and vas deferens are dissected away from the posterior surface of the bladder. This plane which follows the anterior layer of Denonvilliers' fascia is carried up to the bladder neck. The second plane of dissection follows the posterior layer of Denonvilliers' fascia up to the apex of the prostate. The peritoneal incision in the cul-de-sac is closed. After entering the space of Retzius the endopelvic fascia is incised and the remainder of the procedure follows the standard retropubic approach. This technique may be used for salvage prostatectomy to avoid rectal injury.