364:
25:
438:(TURP), open or laser enucleation of adenoma and laser vaporisation of prostate. However, retrograde ejaculation is a common problem. Preservation of ejaculation is the aim of some new techniques. Once the prostate and vesicles are removed, even if partial erection is achieved, ejaculation is a very different experience, with little of the compulsive release that is common to ejaculation with those organs intact.
430:. Radical prostatectomy is associated with greater decrease in sexual function than external beam radiotherapy. Nerve-sparing surgery reduces the risk that patients will experience erectile dysfunction. However, the experience and the skill of the nerve-sparing surgeon are critical determinants of the likelihood of positive erectile function of the patient.
380:
describes a procedure that accesses the prostate by going through the lower abdomen and behind the pubic bone. A suprapubic prostatectomy describes a procedure cuts through the lower abdomen and through the bladder to access the prostate. A perineal prostatectomy is done by making an incision between the rectum and scrotum on the underside of the abdomen.
563:, MD (1903–1980) developed the radical retropubic prostatectomy in 1945. American urologist Patrick C. Walsh, MD (1938—present) developed the modern nerve-sparing, retropubic prostatectomy with minimal blood loss. The first laparoscopic prostatectomy was performed in 1991 by William Schuessler, MD and colleagues in Texas.
393:(CALP), there can be similar advantages over open prostatectomy, including smaller incisions, less pain, less bleeding, less risk of infection, faster healing time, and shorter hospital stay. The cost of this procedure is higher, while long-term functional and oncological superiority have yet to be established.
1166:
Averbeck, Marcio A.; Woodhouse, Christopher; Comiter, Craig; Bruschini, Homero; Hanus, Thomas; Herschorn, Sender; Goldman, Howard B. (23 October 2018). "Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th
International Consultation on Incontinence".
388:
Robotic-assisted instruments are inserted through several small abdominal incisions and controlled by a surgeon. Some use the term 'robotic' for short, in place of the term 'computer-assisted'. However, procedures performed with a computer-assisted device are performed by a surgeon, not a robot. The
379:
In an open prostatectomy, the prostate is accessed through a large single incision through either the lower abdomen or the perineum. Further descriptive terms describe how the prostate is accessed anatomically through this incision (retropubic vs. suprapubic vs. perineal). A retropubic prostatectomy
450:
devices such as condom catheters or diaper pads. A large analysis of the incidence of urinary incontinence found that 12 months after surgery, 75% of patients needed no pad, while 9–16% did. Factors associated with increased risk of long-term urinary incontinence include older age, higher BMI, more
279:
By laser prostatectomy (HoLEP - Holmium laser enucleation of the prostate), a laser is used to cut and remove the excess prostate tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men
401:
Complications that occur in the period right after any surgical procedure, including a prostatectomy, include a risk of bleeding, a risk of infection at the site of incision or throughout the whole body, a risk of a blood clot occurring in the leg or lung, a risk of a heart attack or stroke, and a
466:
placement in urinary incontinence following prostatectomy achieved 86% at a median follow-up of 22 months. Artificial urinary sphincters are offered for moderate-to-severe urinary incontinence in males and have shown good long-term efficacy and safety. The use of artificial urinary sphincters for
341:
A radical prostatectomy is performed due to malignant cancer. For prostate cancer, the best treatment often depends on the risk level presented by the disease. For most prostate cancers classified as "very low risk" and "low risk", radical prostatectomy is one of several treatment options; others
535:
Though a very common procedure, the experience level of the surgeon performing the operation is important in determining the outcomes, rate of complications, and side effects. The more prostatectomies performed by a surgeon, the better the outcomes. This is true for prostatectomies done as open
417:
listed the incidence of several complications following radical prostatectomy: mortality <0.3%, impotence >50%, ejaculatory dysfunction 100%, orgasmic dysfunction 50%, incontinence <5–30%, pulmonary embolism <1%, rectal injury <1%, urethral stricture <5%, and transfusion 20%.
1080:
Ficarra, Vincenzo; Novara, Giacomo; Rosen, Raymond C.; Artibani, Walter; Carroll, Peter R.; Costello, Anthony; Menon, Mani; Montorsi, Francesco; Patel, Vipul R. (September 2012). "Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical
876:
Barocas, D. A.; Salem, S.; Kordan, Y.; Herrell, S. D.; Chang, S. S.; Clark, P. E.; Davis, R.; Baumgartner, R.; Phillips, S.; Cookson, M. S.; Smith Jr, J. A. (2010). "Robotic
Assisted Laparoscopic Prostatectomy Versus Radical Retropubic Prostatectomy for Clinically Localized Prostate Cancer:
313:
346:
when the cancer has spread through the prostate, to the lymph nodes or other parts of the body. Prior to deciding the best treatment option for higher risk cancers, imaging studies using CT, MRI or bone scans are done to make sure the cancer has not spread outside of the prostate.
433:
Following a prostatectomy, patients will not be able to ejaculate semen due to the nature of the procedure, resulting in the permanent necessity of assisted reproductive techniques in case of desires of future fertility. Preservation of normal ejaculation is possible after
298:
surrounding and close to the prostate are taken out (typically the area defined by external iliac vein anteriorly, the obturator nerve posteriorly, the origin of the internal iliac artery proximally, Cooper's ligament distally, the bladder medially and the pelvic side wall
131:
342:
include radiation, watchful waiting, and active surveillance. For intermediate and high risk prostate cancers, radical prostatectomy is often recommended in addition to other treatment options. Radical prostatectomy is not recommended in the setting of known
1036:
Alloussi, Saladin Helmut; Lang, Christoph; Eichel, Robert; Alloussi, Schahnaz (2013-08-19). "Ejaculation-Preserving
Transurethral Resection of Prostate and Bladder Neck: Short- and Long-Term Results of a New Innovative Resection Technique".
409:
is inserted in the urinary tract of a person allergic to latex. That is especially severe in case of a radical prostatectomy due to the open wound there and the exposure lasting e.g. two weeks. Intense pain may indicate such situation.
1418:
Moul, J. W. (August 2002). "Epidemiology of radical prostatectomy for localized prostate cancer in the era of prostate-specific antigen: an overview of the
Department of Defense Center for Prostate Disease Research national database".
990:
John P. Mulhall, M.D., Saving Your Sex Life: A Guide for Men with
Prostate Cancer, Chicago, Hilton Publishing Company, 2008, pp. 56, 58, Table 1: Factors Predicting Erectile Function Recovery after Radical Prostatectomy, p.
389:
computer-assisted device gives the surgeon more dexterity and better vision, but no tactile feedback compared to conventional laparoscopy. When performed by a surgeon who is specifically trained and well experienced in
772:
O’Neil, Brock; Koyama, Tatsuki; Alvarez, JoAnn; Conwill, Ralph M.; Albertsen, Peter C.; Cooperberg, Matthew R.; Goodman, Michael; Greenfield, Sheldon; Hamilton, Ann S.; Hoffman, Karen E.; Hoffman, Richard M. (2016).
531:
The use of radical prostatectomy as treatment for prostate cancer increased significantly from 1980 to 1990. As of 2000, the median age of men undergoing radical prostatectomy for localized prostate cancer was 62.
462:. Although there are limited data on the long-term outcomes in males, perineal slings are offered for mild-to-moderate post-prostatectomy incontinence. In a retrospective study the success rate of perineal
302:
Extended pelvic lymph node dissection (PLND): lymph nodes farther away from the prostate are taken out also (typically the area defined in a limited PLND with the posterior boundary as the floor of the
413:
Men can experience changes in their sexual responses after radical prostatectomy, including impairments to sexual desire, penile morphology and orgasmic function. A 2005 article in the medical journal
559:
MD developed the open, radical and perineal prostatectomies in 1904 at Johns
Hopkins Brady Urological Institute, the first version of the procedure that became generally feasible. The Irish surgeon
489:
Very few surgeons will claim that patients return to the erectile experience they had prior to surgery. The rates of erectile recovery that surgeons often cite are qualified by the addition of
829:
Cost
Analysis of Radical Retropubic, Perineal, and Robotic Prostatectomy; Scott V. Burgess, Fatih Atug, Erik P. Castle, Rodney Davis, Raju Thomas; Journal of Endourology 2006 20:10, 827–830
571:
A 2014 survey of prostatectomy fees for uninsured patients at 70 United States hospitals found an average facility fee of $ 34,720 and average surgeon and anesthesiologist fees of $ 8,280.
1264:
Siracusano, Salvatore; Visalli, Francesco; Favro, Michele; Tallarigo, Carlo; Kugler, Mauro; Kugler, Alexander; Diminutto, Alberto; Talamini, Renato; Artibani, Walter (13 September 2017).
841:
Bolenz, C.; Gupta, A.; Hotze, T.; Ho, R.; Cadeddu, J.; Roehrborn, C.; Lotan, Y. (2010). "Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer".
1001:
Tran, Stéphanie; Boissier, Romain; Perrin, Jeanne; Karsenty, Gilles; Lechevallier, Eric (2015). "Review of the
Different Treatments and Management for Prostate Cancer and Fertility".
1813:
Pate, S. C., Uhlman, M. A., Rosenthal, J. A., Cram, P., Erickson, B. A. (March 2014). "Variations in the open market costs for prostate cancer surgery: a survey of US hospitals".
329:, bladder stones secondary to bladder outlet obstruction, significant symptoms from bladder outlet obstruction that are refractory to medical or minimally invasive therapy, and
1220:
653:
241:(also known as a subtotal prostatectomy) involves the removal of only part of the prostate. Surgeons typically carry out simple prostatectomies only for
46:
39:
1903:
1516:
1848:
1566:
1503:
446:
Prostatectomy patients have an increased risk of leaking small amounts of urine immediately after surgery, and for the long-term, often requiring
325:
Indications for removal of the prostate in a benign setting include acute urinary retention, recurrent urinary tract infections, uncontrollable
153:
149:
477:
have little role in the management of post-prostatectomy incontinence and there is weak evidence that these agents can offer any improvement.
1973:
912:
1456:"The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point"
1124:
Kretschmer, Alexander; Nitti, Victor (October 2017). "Surgical
Treatment of Male Postprostatectomy Incontinence: Current Concepts".
1396:
John P. Mulhall, M.D., Saving Your Sex Life: A Guide for Men with
Prostate Cancer, Chicago, Hilton Publishing Company, 2008, p. 69.
1239:
1956:
1865:
1517:
Vickers, A. J., Savage C. J, Hruza, M., Tuerk, I., Koenig, P., Martínez-Piñeiro, L., Janetschek, G., Guillonneau, B. (May 2009).
435:
1637:
968:
547:, MD is generally credited for performing the first intentional prostatectomy via the suprapubic route in 1885, 1886 or 1887 at
1929:
830:
1968:
1896:
1737:
Walsh, PC (2007). "The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy".
1620:
1233:
690:
637:
89:
2194:
1870:
1405:
John P. Mulhall, M.D., Saving Your Sex Life: A Guide for Men with Prostate Cancer, Chicago, Hilton Publishing Company, 2008
1358:"Urinary artificial sphincter ZSI 375 for treatment of stress urinary incontinence in men: 5 and 7 years follow-up report"
61:
1611:
Zorgniotti, AW (2012). "Suprapubic prostatectomy: An Anglo-American success story". In Hinman Jr, F; Boyarsky, S (eds.).
1312:"Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.5 years of followup"
760:
Center for the Advancement of Health; August 29, 2005; Robot-assisted Prostate Surgery Has Possible Benefits, High Cost
260:
There are multiple ways the operation can be done: with open surgery (via a large incision through the lower abdomen),
2128:
1453:
108:
68:
1961:
1889:
1638:"VIII. Conservative perineal prostatectomy: The results of two years' experience and report of seventy-five cases"
981:
Sexual Dysfunction after Radical Prostatectomy; Andrew R McCullough; Reviews in Urology; 2005 7:(Suppl 2), S3–S10.
468:
75:
1881:
2204:
2199:
1219:
Burkhard, F.C.; Bosch, J.L.H.R.; Cruz, F.; Lemack, G.E.; Nambiar, A.K.; Thiruchelvam, N.; Tubaro, A. (2018).
478:
459:
57:
474:
454:
Surgical management options for urinary incontinence secondary to prostatectomy include implantation of
451:
comorbidities, larger prostates surgically excised, as well as experience and technique of the surgeon.
2189:
1812:
1702:
Millin, T (1945). "Retropubic prostatectomy: A new extravesical technique report; report of 20 cases".
500:
390:
1265:
580:
1454:
Vickers, A., Bianco, F., Cronin, A., Eastham, J., Klein, E., Kattan, M., Scardino, P. (April 2010).
1913:
732:
510:
160:
1519:"The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study"
761:
556:
35:
1311:
707:
505:
455:
426:
Surgical removal of the prostate contains an increased likelihood that patients will experience
2138:
1983:
330:
190:
291:
that promote penile erections are left behind in the body and not taken out with the prostate.
1842:
1560:
1497:
2123:
1944:
548:
447:
427:
82:
1310:
Haab, Francois; Trockman, Brett A.; Zimmern, Philippe E.; Leach, Gary E. (1 August 1997).
928:"Prostate-induced orgasms: A concise review illustrated with a highly relevant case study"
8:
2133:
601:
2168:
2143:
2041:
2031:
1939:
1875:
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1830:
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1548:
1485:
1436:
1379:
1331:
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1229:
1184:
1141:
1106:
1098:
1062:
1054:
1018:
949:
894:
858:
812:
794:
775:"The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples"
686:
633:
144:
1196:
1990:
1822:
1785:
1746:
1711:
1660:
1652:
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1538:
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1266:"Argus-T Sling in 182 Male Patients: Short-Term Results of a Multicenter Study"
890:
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560:
520:
463:
219:
1137:
2183:
2036:
1978:
1102:
1058:
798:
552:
283:
Other terms that can be used to describe a prostatectomy include:
1432:
2095:
2018:
1834:
1758:
1723:
1674:
1552:
1489:
1440:
1383:
1289:
1188:
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295:
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176:
2073:
2066:
1374:
1357:
515:
490:
467:
post-prostatectomy incontinence is supported by the recommendations of
343:
1180:
496:
Remedies to the problem of post-operative sexual dysfunction include:
2100:
2026:
944:
927:
326:
242:
223:
1581:
481:
can speed recovery of urinary incontinence following prostatectomy.
355:
These would be same as the contraindications for any other surgery.
24:
2053:
1921:
1774:"Laparoscopic radical prostatectomy: Initial short-term experience"
606:
406:
363:
273:
215:
136:
966:
1165:
269:
1771:
877:
Comparison of Short-Term Biochemical Recurrence-Free Survival".
484:
1772:
Schuessler, WW; Schulam, PG; Clayman, RV; Kavoussi, LR (1997).
1263:
967:
Wehrwein, Peter; Harvard Prostate Knowledge (15 October 2013).
536:
procedures and those done using minimally invasive techniques.
312:
288:
209:
204:
198:
193:
1228:. Arnhem, The Netherlands: European Association of Urology.
654:"HoLEP Procedure: Holmium Laser Enucleation of the Prostate"
130:
1079:
1035:
1000:
771:
875:
742:. National Comprehensive Cancer Network. October 24, 2014
1309:
226:
conditions that cause urinary retention, as well as for
1356:
Llorens, Christophe; Pottek, Tobias (25 October 2017).
1218:
16:
Surgical removal of all or part of the prostate gland
371:
There are several ways a prostatectomy can be done:
268:(a type of minimally invasive surgery), through the
1866:
The Basics of the Prostatectomy Procedure Explained
840:
733:"NCCN Guidelines version 1.2015 – Prostate Cancer"
1582:"Present status of the surgery of prostate gland"
333:secondary to chronic bladder outlet obstruction.
2181:
1222:EAU Guidelines on Urinary Incontinence in Adults
471:and International Consultation on Incontinence.
249:, the removal of the entire prostate gland, the
1123:
237:There are two main types of prostatectomies. A
969:"Achieving orgasm after radical prostatectomy"
632:. New York: McGraw Hill Medical. p. 368.
1974:Transurethral needle ablation of the prostate
1897:
1355:
485:Remedies to post-operative sexual dysfunction
1847:: CS1 maint: multiple names: authors list (
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294:Limited pelvic lymph node dissection: the
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475:Transurethral injection of bulking agents
405:Severe irritation takes place if a latex
109:Learn how and when to remove this message
960:
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1957:Transurethral resection of the prostate
685:. J. Wieder Medical. pp. 141–142.
441:
436:transurethral resection of the prostate
421:
280:who have a severely enlarged prostate.
2182:
1930:Transurethral incision of the prostate
1701:
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1212:
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1208:
1206:
1161:
1159:
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45:Please improve this article by adding
1969:Transurethral microwave thermotherapy
1885:
1736:
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1411:
925:
705:
680:
599:
383:
287:Nerve-sparing: the blood vessels and
1417:
676:
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350:
18:
1912:Tests and procedures involving the
1203:
1152:
630:Smith and Tanagho's General Urology
13:
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2216:
2129:Frenuloplasty of prepuce of penis
1859:
706:Khera, Mohit (October 23, 2013).
671:
600:Khera, Mohit (October 23, 2013).
1962:Radical retropubic prostatectomy
1657:10.1097/00000658-190504000-00006
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469:European Association of Urology
307:
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699:
646:
621:
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218:removal of all or part of the
1:
1827:10.1016/j.urology.2013.09.066
1791:10.1016/s0090-4295(97)00543-8
1716:10.1016/S0140-6736(45)91030-0
1535:10.1016/S1470-2045(09)70079-8
1328:10.1016/S0022-5347(01)64496-3
1282:10.1016/j.urology.2017.07.058
1015:10.1016/j.urology.2015.07.010
586:
460:artificial urinary sphincters
391:computer-assisted laparoscopy
230:and for other cancers of the
222:. This operation is done for
47:secondary or tertiary sources
1613:Benign Prostatic Hypertrophy
1169:Neurourology and Urodynamics
1095:10.1016/j.eururo.2012.05.045
971:. Harvard Health Publishing.
855:10.1016/j.eururo.2009.11.008
479:Pelvic floor muscle training
336:
210:
199:
7:
2195:Surgical removal procedures
1598:10.1056/nejm190308131490701
574:
506:Intraurethral suppositories
257:, is performed for cancer.
10:
2221:
1751:10.1016/j.juro.2007.01.012
1615:. Spring. pp. 45–58.
1472:10.1016/j.juro.2009.12.015
891:10.1016/j.juro.2009.11.017
791:10.1016/j.juro.2015.08.092
628:McAninch, Jack W. (2008).
539:
316:Prostate and nearby organs
205:
194:
2156:
2119:
2091:
2082:
2052:
2017:
1999:
1920:
1138:10.1016/j.euf.2017.11.007
581:List of surgeries by type
555:MD in collaboration with
493:to the recovery regimen.
359:Techniques and approaches
320:
173:
159:
143:
128:
123:
1914:male reproductive system
566:
1433:10.1067/msy.2002.125315
913:"Radical Prostatectomy"
683:Pocket Guide to Urology
681:Wider, Jeff A. (2014).
658:www.hopkinsmedicine.org
557:William Stewart Halsted
397:Risks and complications
374:
2139:Penile plethysmography
1984:Prostate brachytherapy
1126:European Urology Focus
1039:Journal of Endourology
879:The Journal of Urology
708:"Simple Prostatectomy"
602:"Simple Prostatectomy"
368:
331:chronic kidney disease
317:
34:relies excessively on
1580:Thorndike, P (1903).
1051:10.1089/end.2013.0093
926:Levin, R. J. (2018).
366:
315:
247:radical prostatectomy
214:, "excision") is the
2205:Prostatic procedures
2200:Male genital surgery
2124:Foreskin restoration
1945:Transurethral biopsy
549:Cook County Hospital
448:urinary incontinence
442:Urinary incontinence
428:erectile dysfunction
422:Erectile dysfunction
239:simple prostatectomy
2134:Penile Frenulectomy
264:with the help of a
2169:Scrotal ultrasound
2144:Postage stamp test
2042:Vasoepididymostomy
2032:Vasectomy reversal
1940:Transrectal biopsy
1876:The New York Times
1636:Young, HH (1905).
1460:Journal of Urology
1375:10.5301/uj.5000243
1316:Journal of Urology
779:Journal of Urology
415:Reviews in Urology
384:Minimally invasive
369:
318:
2190:Surgical oncology
2177:
2176:
2152:
2151:
2009:Spermatocelectomy
1710:(6380): 693–696.
1622:978-1-4612-5478-2
1586:Boston Med Surg J
1235:978-94-92671-01-1
1181:10.1002/nau.23845
692:978-0-9672845-6-9
639:978-0-07-162497-8
511:Penile injections
351:Contraindications
203:, "prostate" and
184:
183:
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2001:Seminal vesicles
1991:Prostate massage
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1745:(5): 1632–1635.
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1677:. Archived from
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1238:. Archived from
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1132:(4–5): 364–376.
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1081:prostatectomy".
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945:10.1002/ca.23006
932:Clinical Anatomy
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915:. November 2021.
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838:
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367:Prostate Removal
262:laparoscopically
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228:prostate cancer
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135:Anatomy of the
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99:November 2020
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54:Find sources:
48:
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32:This article
30:
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2096:Circumcision
2019:Vas deferens
1951:
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1686:. Retrieved
1679:the original
1648:
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1561:cite journal
1526:
1523:Lancet Oncol
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1498:cite journal
1463:
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1351:
1339:. Retrieved
1319:
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1247:. Retrieved
1240:the original
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746:November 13,
744:. Retrieved
739:
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660:. 2023-08-02
657:
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605:
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551:in Chicago.
543:
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527:Epidemiology
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308:Medical uses
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255:vas deferens
246:
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186:
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96:
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79:
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65:
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2157:Other tests
2062:Orchiectomy
1276:: 177–183.
613:November 8,
501:Medications
299:laterally).
296:lymph nodes
2184:Categories
2074:Orchiopexy
2067:Castration
1688:2018-01-21
1341:21 January
1295:21 January
1249:21 January
664:2024-03-04
587:References
491:sildenafil
344:metastases
189:(from the
69:newspapers
36:references
2101:Penectomy
2027:Vasectomy
1103:1873-7560
1059:0892-7790
799:0022-5347
337:Malignant
327:hematuria
200:prostátēs
195:προστάτης
1922:Prostate
1835:24439795
1759:17437775
1724:21007347
1675:17861622
1645:Ann Surg
1553:19342300
1490:20171687
1441:12219014
1384:28525665
1290:28917606
1197:53039893
1189:30350875
1146:29174616
1111:22749852
1067:23952037
1023:26368508
954:29265651
899:20083261
863:19931979
817:26343985
712:Medscape
607:Medscape
575:See also
407:catheter
303:pelvis).
274:perineum
253:and the
216:surgical
145:ICD-9-CM
137:prostate
1815:Urology
1800:9426713
1778:Urology
1666:1426005
1544:2777762
1481:2861336
1421:Surgery
1336:9224318
1270:Urology
1003:Urology
808:4916911
540:History
270:urethra
167:D011468
83:scholar
2054:Testes
1833:
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1739:J Urol
1722:
1704:Lancet
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321:Benign
289:nerves
243:benign
232:pelvis
224:benign
211:ektomē
206:ἐκτομή
85:
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2084:Penis
1682:(PDF)
1641:(PDF)
1243:(PDF)
1226:(PDF)
1193:S2CID
736:(PDF)
567:Costs
464:sling
266:robot
191:Greek
175:[
90:JSTOR
76:books
1849:link
1831:PMID
1796:PMID
1755:PMID
1720:PMID
1671:PMID
1617:ISBN
1567:link
1549:PMID
1504:link
1486:PMID
1437:PMID
1380:PMID
1343:2020
1332:PMID
1297:2020
1286:PMID
1251:2020
1230:ISBN
1185:PMID
1142:PMID
1107:PMID
1099:ISSN
1063:PMID
1055:ISSN
1019:PMID
950:PMID
895:PMID
859:PMID
813:PMID
795:ISSN
748:2014
719:2014
687:ISBN
634:ISBN
615:2014
458:and
375:Open
161:MeSH
154:60.6
150:60.2
62:news
1823:doi
1786:doi
1747:doi
1743:177
1712:doi
1661:PMC
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