The radical or total prostatectomy is in fact a radical prostato-vesiculectomy.
The intervention indeed consists in removing all the prostate and the seminal vesicles.
The extent of the excision is indicated on the drawing opposite to the left by the organs of purple color.
Vas deferens are cut.
The dissection technique for the apex of the prostate respects the urinary striated sphincter during the section of the urethra, to preserve continence.
At the end of this dissection, there is a discontinuity between bladder and urethra. The bladder has to come down like a parachute on the urethra to reconstitute the route of the urinary flow.
The bladder was widely freed by the dissection and we can face both organs without any excessive tension.
After the withdrawal of the prostate, the bladder neck, preserved during the dissection of the base of the prostate or reconstituted, is directly stitched to the canal of the urethra to constitute a delicate Bladder-to-Urethra anastomosis.
This anastomosis is manually performed by the surgeon by means of absorbable surgical sutures, on a bladder indwelling catheter which allows the sutures to heal “dry”.
Urine should not get through the stitches of this suture and it is the catheter that drains all the urinary flow from the bladder to prevent this.
The surgeon controls and confirms the waterproofness of his anastomosis with a test during the intervention. He fills the bladder through the urinary catheter set up in place at the end of his suture.
In certain cases, in particular if the rate of PSA is above 10 ng / ml or if the scanner (TDM) or the MRI suspect that the pelvic lymph nodes are pathological, they are also removed during the same intervention to be later analyzed.
A pelvic lymphadenectomy is then realized to supplement the prostate ablation.