The UNC Department of Urology is helping to bring new and innovative surgical options to N.C.
At some point, approximately 1 in 3 men with localized prostate cancer will undergo a “prostatectomy,” which involves removal of the prostate.
While most men do well after a prostatectomy, one complication can be temporary urinary incontinence. In approximately 5% of cases, this incontinence can be significant and long-term.
At UNC, leading experts are utilizing innovative surgical techniques that are designed to maximize benefits for patients undergoing prostatectomies while helping to minimize potential risks.
What is RALP?
Robotic Assisted Laparoscopic Prostatectomy (RALP) is a minimally invasive surgery for men with prostate cancer. The procedure involves making a series of small holes in the abdomen through which robotic arms controlled by the surgeon are used to remove the prostate with a high degree of accuracy and precision.
RALP is now the most common type of prostatectomy performed in the U.S.
“Retzius-Sparing” RALP Surgery Helps Protect Important Structures
One type of “RALP” procedure being utilized by UNC Urology is referred to as Retzius-Sparing or Pelvic Fascia-Sparing RALP. In this procedure, the surgeon removes the prostate from behind the prostate/bladder, rather than from above, leaving the Retzius (the area located behind the pubic bone) untouched. As a result, it leaves intact internal structures that help provide bladder control in men. There may also be other benefits including less inguinal hernias, penile shortening, and penile curvature (i.e., Peyronie’s disease).
While a conventional RALP procedure usually results in good bladder control for most men, Retzius-sparing surgeries may provide faster recovery and resumption of return to the patients’ normal lifestyle.
UNC is one of only a few medical centers in North Carolina to utilize the advanced surgical technique.
“We’re very excited to bring innovative procedures to N.C. that can help minimize potential side effects for those who need treatment for their prostate cancer.”
“It’s gratifying to offer a technique that can help patients get back to their normal activities more quickly.”
Hung-Jui (Ray) Tan, MD, MSHPM
Director of Urologic Oncology,
Urologic Oncology Fellowship Program Director,
Associate Professor of Urology
Transvesical RALP Procedure Also Offers Multiple Benefits
Another advanced surgical technique is referred to as “Transvesical RALP,” in which the prostate is accessed through the bladder.
For appropriate patients, this point of entry offers advantages similar to the Retzius sparing technique, as the internal structures around the prostate are left intact. The procedure is performed using the Single Port (SP) robot rather than the traditional multiport robot. As a result, men only have a single 4 cm incision above their pubic bone.
Patients undergoing SP Transvesical RALP typically have fewer urinary and other complications, experience less discomfort and therefore may need less pain medication, and are often able to return home and to work more quickly than with more traditional robotic laparoscopic procedures.
Additionally, the procedure may be a good option for men who have had prior abdominal surgery. By operating on the prostate directly through the bladder, this single-port surgical approach bypasses the abdomen and therefore eliminates the potential for injury to the bowel or adjacent structures. As with similar techniques, the use of robotic arms controlled by the surgeon provide enhanced accuracy and safety for the patient.
“Introducing the single-port transvesical robotic radical prostatectomy at UNC is truly rewarding, as it allows us to bring an innovative surgical technique to our patients, ensuring they have access to the most advanced treatment options while achieving the best possible outcomes in their care.”
Marc Bjurlin, DO, MSc, FACOS
Vice Chair of Research,
Director of Clinical Trials,
Associate Professor of Urology
The Important Role of Pelvic Floor Physical Therapists
UNC also offers a highly specialized type of physical therapy which provides treatment of the pelvic floor before and after a prostatectomy. Therapists can help educate patients about the parts of their anatomy that might be affected by surgery. A pelvic floor PT will teach patients how to minimize issues regarding bladder, bowel, and sexual function. Guidance from a pelvic floor PT to improve posture, strength, and flexibility will result in patients more quickly regaining bladder control and improving quality of life.
To make an appointment with a pelvic floor PT, contact Centralized Scheduling at (984) 974-6274. Referrals can be faxed to (919) 590-6301.
To Learn More…
If you are interested in knowing more about urologic procedures or related urologic topics, you may visit our website’s Patient Care section, or meet with a provider by contacting one of our UNC Urology clinic locations.
Learn more about urologic cancer care at UNC via this link.
About Our Ahead of the Curve Series
Our “Ahead of the Curve” blog series covers the latest and most effective treatments and techniques in UNC Urology patient care. Urology is a complex and rapidly evolving field, with new advancements and breakthroughs constantly emerging. In this series, we will explore a range of topics related to urology patient care, including advanced surgical procedures, innovative diagnostic techniques, and innovative medical therapies. Our goal is to provide you with an overview of the excellence and innovation happening right here at UNC Urology.