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prostate. And if the operation is performed by an experienced surgeon, preserving potency is common, and few suffer from serious
incontinence.
Having said that, we must add right away that radical prostatectomy is not for everybody. It is intended for the younger man with curable disease, the man otherwise healthy, who can reasonably expect to
live for at least another fifteen years. In other words, it is for the man
who is not only curable, but who's going to live long enough to need
to be cured. It is not something that an older man, or one burdened
by other health problems, should have to put himself through.
The radical prostatectomy operation that's performed today has
evolved over the last twenty years. My role in this operation began in
the early 1970s. I wondered why so many side effects were occurring,
and whether it was possible to avoid them. To solve this problem, I
took an anatomical approach, and soon learned why these complications were so common. Surgeons did not understand the "periprostatic" anatomy, the terrain surrounding the prostate -- the location of
the nerves, arteries, veins, and sphincter muscles. Eventually, I was
able to chart the course of the veins as they traveled over the top of the
prostate. It became clear that there was a relatively narrow trunk that
could be tied off over the urethra to control the major bleeding during
surgery. With this "bloodless field," it became easier to see and save the
anatomical structures that previously had been unrecognized and
damaged during surgery.
During radical prostatectomies, I noticed that there was a cluster
of arteries and veins, consistently located in the same region in adult
men. I speculated that these blood vessels might be the key to preserving potency in surgery. On April 26, 1982,1 performed the first
purposeful "nerve-sparing" radical prostatectomy on a fifty-two-year-
old professor of psychology. This man regained his sexual function
within a year, and has remained complication-free, and cancer-free
ever since. Today, the neurovascular bundle is widely recognized as
the landmark used in nerve-sparing surgery.
Over the last twenty years, I have continued to refine the proce-
dure, making certain that it is an excellent cancer operation, and
attempting to speed up the recovery of urinary control and sexual
function. Most recently, I have used the review of intraoperative
videotapes -- much like football coaches watching the "play by play" of
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