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Surgical anatomy of the puboprostatic complex with special reference to radical perineal prostatectomy
Author(s) -
Wimpissinger T.F.,
Tschabitscher M.,
Feichtinger H.,
Stackl W.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04489.x
Subject(s) - prostatectomy , medicine , anatomy , urology , prostate , cancer
We are always interested in developing an understanding of anatomical relationships, particularly as this can often make surgery more reliable for patients; the classic anatomical studies of Walsh and Donker are remembered by everyone. Here, the authors from Vienna investigate the retropubic space and the attachments of the prostate and urethra to aid the performance of radical perineal prostatectomy. Authors from London describe their criteria based on clinical experience, for performing bone scans in patients with prostate cancer. Their proposals are somewhat more exclusive than some of the suggestions made previously but it is worth considering the authors’ views and seeing whether they might be valid and important guidelines for the future. On the subject of bone metabolism in prostate cancer, authors from the UK suggest that there is a high incidence of osteoporosis in patients with advanced prostate cancer before hormonal manipulation, and that patients requiring such treatment should have densitometry before starting treatment. OBJECTIVE To investigate the retropubic space and attachments of the prostate and urethra, with special reference to radical perineal prostatectomy. MATERIALS AND METHODS Anatomical relationships were assessed intraoperatively in 60 patients, and in five cadavers after preparing the dorsal vein complex with coloured latex. Cross‐sections of the area of interest were evaluated by microscopy. RESULTS The puboprostatic (pubovesical) ligaments could be clearly distinguished from the median part of the puboprostatic complex continuous with the urethral suspensory mechanism. The dorsal vein complex is integrated into this fibromuscular attachment of the prostate and male urethra. During the perineal approach, dissection in this region follows the so‐called avascular plane. CONCLUSION With this new insight into the anatomical relationships the nomenclature derived from radical retropubic prostatectomy could be mirrored. In radical perineal prostatectomy, both the urethral suspensory mechanism and the dorsal vein complex can be preserved.