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A selection from

cover of Walsh's book

this is page 205

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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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