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Current radical surgery against localized prostate cancer (PCa), such as open (Memmelaar, 1949; Reiner & Walsh, 1979; Walsh & Donker, 1982), laparoscopic (Schuessler et al., 1997; Abbou et al., 2000; Guillonneau et al., 2003) or robot-assisted prostatectomy (Binder & Kramer, 2001; Menon et al., 2002; Menon et al., 2004), has a possible risk to injure supporting structures that surround and support the prostate as well as the external sphincter and the neurovascular bundle. As a result, postoperative stress urinary incontinence develops and continues in about 10 % of patients (Stanford et al., 2000; Lepor et al., 2004; Namiki et al., 2009; Menon et al., 2007). Many procedures were introduced to improve the recovery of postoperative sexual function and urinary incontinence: bladder neck suspension or reconstruction (Poon et al., 2000), reconstruction of the rhabdosphincter (Rocco et al., 2007), periurethral suspension of the dorsal vein complex/urethral complex (Patel et al., 2009) and preservation of the neurovascular bundle (Kaiho et al., 2005), but have failed to solve the problems completely until now. The idea of a transurethral approach to resect almost total prostate tissues containing prostate cancer dates back to around 1990 (Valdivia Uria & Lopez Lopez, 1989; Reuter et al., 1991). The technique did not significantly increase the operative morbidity and mortality compared with transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH), and was suggested to be a valid alternative in some patients with prostate cancer. And a recent report concluded that localized prostate cancer could be resected transurethrally as radical as open surgery (Reuter et al., 2008). We thought that the transurethral approach to treat prostate cancer might bring better clinical results in the era of more improved resectoscope and more sensitive PSA test for the follow-up examination. We applied the transurethral technique to manage prostate cancer with the intention to eliminate almost all prostate tissues that contained localized cancer. As we already reported (Morita & Matsuura, 2009), radical transurethral resection of prostate cancer (RTUR-PCa) against localized prostate cancer has a possibility to minimize the injury to the external sphincter because an operator is able to recognize it clearly during the operation. With a minimal injury to the supporting structures of the prostate, we think that urinary continence can be reserved in RTUR-PCa at least at a

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Radical Transurethral Resection of the Prostate: A Possible Radical Procedure Against Localized Prostate Cancer with Almost No Postoperative Urinary Incontinence