Surgical and Radiologic Anatomy

, Volume 32, Issue 7, pp 663–667

Fascia surrounding the prostate: clinical and anatomical basis of the nerve-sparing radical prostatectomy

  • Jean-Nicolas Cornu
  • Véronique Phé
  • Georges Fournier
  • Vincent Delmas
  • Philippe Sèbe
Original Article

DOI: 10.1007/s00276-010-0668-7

Cite this article as:
Cornu, J., Phé, V., Fournier, G. et al. Surg Radiol Anat (2010) 32: 663. doi:10.1007/s00276-010-0668-7

Abstract

Purpose

Nerve-sparing radical prostatectomy (NSRP) is based on anatomical considerations that are still controversial. The aim of this study is to define and describe the anatomy of the fascias surrounding the prostate in a histoembryologic model and during open and laparoscopic approaches to assess their importance in surgical practice.

Methods

An anatomical dissection of three fresh cadavers was conducted to reproduce an open approach. Complementary data under laparoscopic conditions were obtained from images captured from the video feed during a laparoscopic NSRP performed via a transperitoneal approach. A histological study of one fresh 25-week human male fetus, obtained following miscarriage, was also conducted to document the embryologic development of the identified fascias.

Results

Three fascias surrounding the prostate can clearly be individualized both in histologic and clinical conditions. The endopelvic fascia (EF), the prostatic fascia (PF) and the Denonvilliers’ fascia (DF) recover the prostate gland and structure the periprostatic environment. Neurovascular bundles are situated in a triangle formed by PF, EF and DF. Interfascial dissection (between EF and PF) allows nerve-sparing surgery.

Conclusion

When performing radical prostatectomy, it is mandatory to locate EF, PF and DF precisely to respect the neurovascular bundles. Nevertheless, cancer extension and anatomic variations can lead to more extensive procedures.

Keywords

Prostatic fasciaNeurovascular bundlesCavernous nervesInterfascial dissection

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Jean-Nicolas Cornu
    • 1
  • Véronique Phé
    • 1
  • Georges Fournier
    • 2
  • Vincent Delmas
    • 3
  • Philippe Sèbe
    • 1
  1. 1.Urology DepartmentTenon Hospital, University Paris 6Paris Cedex 20France
  2. 2.Department of UrologyCHU Brest, Hôpital de la Cavale Blanche Bd PrigentBrest Cedex 2France
  3. 3.Department of AnatomyUniversity Paris 5ParisFrance