Radical retropubic prostatectomy originally was described by Millin in 1945.<sup>6 Millin T.   Retropubic Urinary Surgery London: Livingstone (1947). 

Haga clic aquí para ir a la sección de Referencias</sup> Many urologists embraced the retropubic approach because they were more familiar with retropubic anatomy. An advantage of the retropubic versus the perineal approach was the ability to perform a simultaneous staging pelvic lymphadenectomy.<sup>13 Walsh P.C., Lepor H. The role of radical prostatectomy in the management of prostate carcinoma Cancer (suppl) 1987 ;  60 (526) : 537

Haga clic aquí para ir a la sección de Referencias</sup> Historically, significant bleeding often was encountered while attempting to control the dorsal venous complex during radical retropubic prostatectomy. One of the advantages of the perineal approach was less intraoperative bleeding because it was not necessary to ligate the dorsal venous complex.<sup>13 Walsh P.C., Lepor H. The role of radical prostatectomy in the management of prostate carcinoma Cancer (suppl) 1987 ;  60 (526) : 537

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Development of the anatomic nerve-sparing radical retropubic prostatectomy by Walsh required a bloodless operative field and a thorough knowledge of pelvic anatomy. Reiner and Walsh<sup>8 Reiner W.G., Walsh P.C. An anatomical approach to the surgical management of the dorsal vein and Santorini's plexus during radical retropubic surgery J Urol 1979 ;  121 : 198-200

Haga clic aquí para ir a la sección de Referencias</sup> described the anatomy of the dorsal venous complex and a surgical technique for ligating this complex in 1977, which greatly diminished the bleeding associated with radical retropubic prostatectomy. Anatomic studies in the early 1980s demonstrated the precise relationship of the cavernous nerves relative to the prostate and other pelvic structures in the human fetus<sup>11 Walsh P.C., Donker P.J. Impotence following radical prostatectomy: Insight into etiology and prevention J Urol 1982 ;  128 : 492-497

Haga clic aquí para ir a la sección de Referencias</sup> and adult.<sup>5 Lepor H., Gregerman M., Crosby R. , y al. Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: A detailed anatomical study of the adjust male pelvis J Urol 1985 ;  133 : 207-212

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These landmark anatomic studies set the stage for Walsh's description of the anatomic nerve-sparing radical retropubic prostatectomy.<sup>11 Walsh P.C., Donker P.J. Impotence following radical prostatectomy: Insight into etiology and prevention J Urol 1982 ;  128 : 492-497

Haga clic aquí para ir a la sección de Referencias</sup> One of the major advantages of the anatomic nerve-sparing retropubic approach is the ability to preserve the cavernous nerves and erectile function in the overwhelming majority of men undergoing prostatectomy for the cure of clinically localized prostate cancer. An equally important advantage is the description of an anatomic surgical technique that greatly diminishes technical complications.

Owing to the widespread acceptance of prostate-specific antigen (PSA) screening in the early 1990s,<sup>1 Brawer M.K., Chetner M.P., Beatie J. , y al. Screening for prostatic carcinoma with prostate specific antigen J Urol 1992 ;  147 : 841-845

Haga clic aquí para ir a la sección de Referencias, 2 Catalona W.J., Smith D.S., Ratliff T.L. , y al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer N Engl J Med 1991 ;  324 : 1156-1161  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> there has been a significant increase in the detection of clinically localized prostate cancer. Currently, radical prostatectomy represents one of the most common surgical procedures performed by urologists in community practice. The increasing experience of individual surgeons coupled with the anatomic nerve-sparing technique has diminished intraoperative technical complications greatly while improving outcomes related to quality of life.<sup>3 Catalona W.J., Carvalhal G.F., Mager D.E. , y al. Potency, continence and complication rates in 1870 consecutive radical retropubic prostatectomies J Urol 1999 ;  161 : 433  [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 14 Walsh P.C., Partin A.W., Epstein J.I. Cancer control and quality of life following anatomical radical retropubic prostatectomy: Results at 10 years J Urol 1994 ;  152 : 1831

Haga clic aquí para ir a la sección de Referencias, 15 Zincke H., Bergstralh E.J., Blute M.L. , y al. Radical prostatectomy for clinically localized prostate cancer: Long-term results of 1143 patients from a single institution J Clin Oncol 1994 ;  12 : 2254

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A new standard now exists for radical retropubic prostatectomy regarding intraoperative and postoperative complications.<sup>10 Shekarriz B., Upadhyay J., Wood P.P. Intraoperative, perioperative and long-term complications of radical prostatectomy Urol Clinics North Am 2001 ;  28 : 639-653  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> In the hands of experts, the surgical procedure is performed in less than 2 hours; the hospital stay is approximately 2 days; the operative mortality rate is typically less than 0.2%; technical complications, including rectal injury, urethral injury, and significant vascular injury, are less than 1%; transfusion rates are less than 10%; significant incontinence is exceedingly rare; and most potent men retain their erectile function.

Since 1986, the author has performed more than 1600 radical retropubic prostatectomies. The author is fortunate to have been the student of Patrick C. Walsh, MD, the developer and master of this operation. The author has not only participated in the evolution of the surgical technique but has witnessed Walsh's passion and commitment to improving the operative procedure. Although the framework of prostatectomy as performed by the author and Walsh is similar, the author's unique technical maneuvers are illustrated in this article. The author is grateful to medical illustrator Tori Guy, who worked diligently to transcribe events in the operating room into the illustrations presented in this manuscript.