Korean J Urol.  2006 Jun;47(6):568-577. 10.4111/kju.2006.47.6.568.

Anatomical Analysis of Prostate and Surrounding Struc-tures: Points to Consider during Radical Retropubic Prostatectomy

• Lee SE
• Byun SS
• Hong SK
• Lee HJ
• Kim YJ
• Chang IH
• Gill MC

• KMID: 2294228
• DOI: http://doi.org/10.4111/kju.2006.47.6.568

Abstract

PURPOSE: To investigate the prevalences of anatomical variations regarding prostate and its surrounding structures, and also the intra- and postoperative effects of such anatomical variations in performing radical retropubic prostatectomy (RRP).
MATERIALS AND METHODS
A retrospective analysis of 156 patients who received RRP for prostate cancer was performed. Patients' records including the results preoperative radiologic evaluations were reviewed. For our analysis, patients were grouped according to the anatomical variations relevant to prostate and surrounding structures shown on preoperative radiographs. Also, patients were interviewed via telephone as needed.
RESULTS
Prostate volume (mean: 41.4ml) measured from preoperative transrectal ultrasound correlated with estimated blood loss (EBL) during RRP (p=0.029). Interspinous diameter (mean: 1.69cm) measured on axial image of preoperative magnetic resonance imaging (MRI) was observed to be inversely correlated with operative time (p=0.010). And, patients with box-shaped deep dorsal vein (as demonstrated on axial view of MRI; 15.3%) were observed to have significantly less EBL during RRP (p=0.030). Also, EBL was significantly higher (p=0.013) for patients in which anterior portion of prostatic apex appeared to overlap and obscure membranous urethra (62.8%). Meanwhile, absence of the distal protrusion of apical region (21.8%) was observed to be associated with early (within 3 postoperative months) recovery of urinary continence (p=0.014).
CONCLUSIONS
Our results suggest that various anatomical variations regarding prostate and its surrounding structure may exist as herein presented, and also that they may indeed have significant effects on both intra- and postoperative course regarding RRPs. Variations in the shape of prostatic apex may be significantly associated with recovery of continence after RRPs.

Keyword

Prostatic neoplasms; Prostatectomy; retropubic; Anatomy

MeSH Terms

Humans
Magnetic Resonance Imaging
Operative Time
Prevalence
Prostate*
Prostatectomy*
Prostatic Neoplasms
Retrospective Studies
Telephone
Ultrasonography
Urethra
Veins

Figure

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  Fig. 1. Greatest diameter of dorsal vein is measured on axial image of Tl-weighted magnetic resonance imaging.

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  Fig. 2. Greatest diameter of membranous urethra is measured on axial image of T2-weighted magnetic resonance imaging.

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  Fig. 3. Membranous urethral length is measured on coronal image of T2-weighted magnetic resonance imaging.

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  Fig. 4. Variable shapes of dorsal vein demonstrated on axial image of magnetic resonance imaging.

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  Fig. 5. Variable shapes of prostate demonstrated on midsagittal image of magnetic resonance imaging.

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