A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy Journal Article


Authors: Walz, J.; Burnett, A. L.; Costello, A. J.; Eastham, J. A.; Graefen, M.; Guillonneau, B.; Menon, M.; Montorsi, F.; Myers, R. P.; Rocco, B.; Villers, A.
Article Title: A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy
Abstract: Context: Detailed knowledge of the anatomy of the prostate and adjacent tissues is mandatory during radical prostatectomy to ensure reliable oncologic and functional outcomes. Objective: To review critically and to summarize the available literature on surgical anatomy of the prostate and adjacent structures involved in cancer control, erectile function, and urinary continence. Evidence acquisition: A search of the PubMed database was performed using the keywords radical prostatectomy, anatomy, neurovascular bundle, fascia, pelvis, and sphincter. Relevant articles and textbook chapters were reviewed, analyzed, and summarized. Evidence synthesis: Anatomy of the prostate and the adjacent tissues varies substantially. The fascia surrounding the prostate is multilayered, sometimes either fused with the prostate capsule or clearly separated from the capsule as a reflection of interindividual variations. The neurovascular bundle (NVB) is situated between the fascial layers covering the prostate. The NVB is composed of numerous nerve fibers superimposed on a scaffold of veins, arteries, and variable amounts of adipose tissue surrounding almost the entire lateral and posterior surfaces of the prostate. The NVB is also in close, cage-like contact to the seminal vesicles. The external urethral sphincter is a complex structure in close anatomic and functional relationship to the pelvic floor, and its fragile innervation is in close association to the prostate apex. Finally, the shape and size of the prostate can significantly modify the anatomy of the NVB, the urethral sphincter, the dorsal vascular complex, and the pubovesical/puboprostatic ligaments. Conclusions: The surgical anatomy of the prostate and adjacent tissues involved in radical prostatectomy is complex. Precise knowledge of all relevant anatomic structures facilitates surgical orientation and dissection during radical prostatectomy and ideally translates into both superior rates of cancer control and improved functional outcomes postoperatively. © 2009 European Association of Urology.
Keywords: cancer surgery; functional assessment; review; postoperative period; outcome assessment; prostate cancer; prostatic neoplasms; prostate; urine incontinence; prostatectomy; nerve fiber; radical prostatectomy; reliability; anatomy; cancer control; seminal vesicle; erectile dysfunction; urinary incontinence; surgical anatomy; urethra; adipose tissue; neurovascular bundle; penis erection; professional knowledge; penis; sphincter; bladder innervation; bladder sphincter; blood vessel innervation; fascia; functional anatomy; pelvis floor
Journal Title: European Urology
Volume: 57
Issue: 2
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2010-02-01
Start Page: 179
End Page: 192
Language: English
DOI: 10.1016/j.eururo.2009.11.009
PUBMED: 19931974
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 18" - "Export Date: 20 April 2011" - "CODEN: EUURA" - "Source: Scopus"
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  1. James Eastham
    422 Eastham