Bladder Neck Incision

After detaching the prostate from the rectum, the gland is gently pulled ventrally by applying traction on the intra-abdominal Foley catheter. The balloon helps to identify the vesicoprostatic comissure.

Non-Bladder Neck-Sparing Technique

Starting at the prostate-vesical junction, the anterior wall of the bladder neck is incised using bipolar coagulation and endoscissors, with the balloon becoming visible. Now the balloon is deflated by cutting the suture at the end of the catheter so that it can be now used as a loop-like retractor. The posterior bladder neck wall is incised, and via retrovesicle access both vasa deferentia and seminal vesicles are dissected following by the incision of the overlying Denonvilliers' fascia.

Bladder Neck-Sparing Technique

Before the division of the bladder neck, the attachments between the bladder and the prostate are incised anteriorly and laterally, thus opening the retrovesicle space and exposing the cranial pedicles, vasa deferentia, and seminal vesicles. Following transaction of these structures between clips, the only part attaching the bladder with the prostate is the bladder neck that is finally divided.

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