METHOD OF IMPLEMENTATION OF RADICAL PROSTATECTOMY

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to operative urology, oncourology, and can be used during surgical intervention in patients with prostate cancer. To do this, two tunnels are alternately formed to the right and left of the projection of the bladder neck in the layer of adipose tissue located medial to the tendon arc of the pelvis and lateral to the pubovesical complex, before the appearance of the vas deferens and seminal vesicles. On the inner surface of the formed tunnels, the outer lateral bundles of the detrusor and the vesicle-prostatic muscle are verified and transected, thus freeing the proximal urethra along the posterolateral semicircle. Then, the tunnels are combined. While moving along the contour of the base of the prostate from the depths to the outside from 6 to 12 o'clock position, the cranial front apron of the detrusor is cut through. Proximal part of the intraprostatic urethra is transected. Seed complex is isolated. Posterior dissection of the prostate is performed. After starting medial to the tendon pelvic arch, the layer is divided between the lateral periprostatic, intrapelvic fascia and fascia of the muscles that raise the anus until the pubic-perineal muscle is exposed on both sides. Focusing on the layer of adipose tissue between the pubovesical complex and the anterior periprostatic fascia, they are separated to the urethral sphincter, while the dorsal venous complex is not pierced. Distal intraprostatic urethra is isolated and transected, the prostate gland is transferred to a container for subsequent retrieval. Anastomosis is laid between the proximal and distal urethra in continuous or interrupted sutures. Tendonal arches of the pelvis and the pubovesical complex are fixed with sutures to the bladder neck.;EFFECT: method minimizes the risk of developing postoperative urinary incontinence after radical prostatectomy by eliminating resection of the muscles that raise the anus, preservation of the bladder neck and the proximal part of the intraprostatic urethra, as well as by preserving the intrapelvic fascia.;1 cl, 1 ex