Fascia surrounding the prostate: clinical and anatomical basis of the nerve-sparing radical prostatectomy
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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.
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.
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.
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.
- Fascia surrounding the prostate: clinical and anatomical basis of the nerve-sparing radical prostatectomy
Surgical and Radiologic Anatomy
Volume 32, Issue 7 , pp 663-667
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- Prostatic fascia
- Neurovascular bundles
- Cavernous nerves
- Interfascial dissection
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- Author Affiliations
- 1. Urology Department, Tenon Hospital, University Paris 6, 4 rue de la Chine, 75970, Paris Cedex 20, France
- 2. Department of Urology, CHU Brest, Hôpital de la Cavale Blanche Bd Prigent, 29609, Brest Cedex 2, France
- 3. Department of Anatomy, University Paris 5, Rue des Saints Pères, 75006, Paris, France