TAILIEUCHUNG - Chapter 091. Benign and Malignant Diseases of the Prostate (Part 6)

Radical Prostatectomy The goal of radical prostatectomy is to excise the cancer completely with a clear margin, to maintain continence by preserving the external sphincter, and to preserve potency by preserving the autonomic nerves in the neurovascular bundle. Radical prostatectomy is advised for patients with a life expectancy of 10 years and is performed using a retropubic, perineal, or laparoscopic approach. Outcomes can be predicted using postoperative nomograms that consider pretreatment factors and the pathologic findings at surgery. PSA failure is defined as a value above or ng/mL, although the exact definition varies among series. There is controversy over. | Chapter 091. Benign and Malignant Diseases of the Prostate Part 6 Radical Prostatectomy The goal of radical prostatectomy is to excise the cancer completely with a clear margin to maintain continence by preserving the external sphincter and to preserve potency by preserving the autonomic nerves in the neurovascular bundle. Radical prostatectomy is advised for patients with a life expectancy of 10 years and is performed using a retropubic perineal or laparoscopic approach. Outcomes can be predicted using postoperative nomograms that consider pretreatment factors and the pathologic findings at surgery. PSA failure is defined as a value above or ng mL although the exact definition varies among series. There is controversy over the definition of what constitutes high risk based on a predicted probability of success or failure. In these situations nomograms and predictive models can only go so far. Exactly what probability of success or failure would lead a physician to recommend and a patient to seek alternative approaches is controversial. For example it may be appropriate to recommend radical surgery for a younger patient with a low probability of cure. Prostatectomy techniques continue to improve as the ability to determine whether the tumor is localized to the gland improves based on different biopsy algorithms and with imaging. The result is better case selection and better surgical planning which in turn have led to more rapid recovery and higher rates of continence and potency. Factors associated with incontinence include older age and shorter urethra length. The specific surgical technique open vs. laparoscopic vs. robotic as well as the skill and experience of the surgeon are also factors for the preservation of neurovascular bundles and development of an anastomotic stricture. Surgical experience is also a factor. In a series treated at an academic center 6 of patients had mild stress urinary incontinence SUI requiring 1 pad day 2 moderate SUI 1 pad .

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