Abstract
The magnetic resonance imaging (MRI) appearances of recurrent prostate cancer following radical prostatectomy have been documented in the radiology literature; however little has been written on the range of normal post-operative appearances. Common routes of surgical access for radical prostatectomy include retropubic and transperineal, although newer minimally invasive methods are gaining increasing acceptance. Specifically the range of appearances of the anastomotic site, the prostatic bed, the position of the bladder base, periurethral tissue, levator sling, rectum and residual seminal vesicles (if present) are demonstrated. A non-enhancing low signal nodule is frequently seen at the vesicourethral anastomosis or within the seminal vesicle remnant and usually represents fibrosis. Appearances following different surgical accesses do not differ tremendously, although the retropubic fat pad is reduced or absent following a retropubic approach. Anterior rectal-wall scarring may be present following a transperineal approach. Other post-surgical findings that may mimic disease include a lymphocoele and injected bladder-neck bulking agent. Many patients referred for MRI following radical prostatectomy will have a pathological study showing disease recurrence, although in non-pathological studies the radiological features can differ significantly. It is important for the radiologist to be aware of the spectrum of normal post-surgical appearances so not to confuse these with locally recurrent disease.
Similar content being viewed by others
References
Petit JH, Chen MH, Loffredo M, Sussman B, Renshaw AA, D’Amico AV (2006) Prostate-specific antigen recurrence and mortality after conventional dose radiation therapy in select men with low-risk prostate cancer. Cancer 107:2180–2185
Hricak H, Schoder H, Pucar D et al (2003) Advances in imaging in the postoperative patient with a rising prostate-specific antigen level. Semin Oncol 30:616–634
Geary ES, Dendinger TE, Freiha FS, Stamey TA (1995) Nerve sparing radical prostatectomy: a different view. J Urol 154:145–149
Ghavamian R, Zincke H (1999) An updated simplified approach to nerve-sparing radical retropubic prostatectomy. BJU Int 84:160–163
Young HH (1905) The early diagnosis and radical cure of carcinoma of the prostate. Bull Johns Hopkins Hosp 16:315–321
Millin T (1947) Carcinoma of the prostate: radical retropubic prostatectomy. In: Millen TE (ed) Retropubic urinary surgery. Williams and Wilkins, Baltimore, pp 15–17
Harris MJ, Thompson IM (1996) The anatomic radical perineal prostatectomy: a contemporary and anatomic approach. Urology 48:762–768
Lassen PM, Kearse WS (1995) Rectal injuries during radical perineal prostatectomy. Urology 45:266–269
Dahm P, Silverstein AD, Weizer AZ et al (2003) A longitudinal assessment of bowel related symptoms and fecal incontinence following radical perineal prostatectomy. J Urol 169(6):2220–2224
Korman HJ, Leu PB, Huang RR, Goldstein NS (2002) A centralized comparison of radical perineal and retropubic prostatectomy specimens: is there a difference according to the surgical approach? J Urol 168:991–994
Yang BK, Young MD, Calingaert B et al (2004) Prospective and longitudinal patient self-assessment of health-related quality of life following radical perineal prostatectomy. J Urol 172:264–268
Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR (1997) Laparoscopic radical prostatectomy: initial short-term experience. Urology 50:854–857
Guillonneau B, el-Fettouh H, Baumert H et al (2003) Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases at the Montsouris Institute. J Urol 169:1261–1266
Menon M, Shrivastava A, Tewari A et al (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168:945–949
Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60:864–868
Joseph JV, Rosenbaum R, Madeb R, Erturk E, Patel HR (2006) Robotic extraperitoneal radical prostatectomy: an alternative approach. J Urol 175:945–950; discussion 951
Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L (2006) Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol 176:2432–2437
Buckley DL, Roberts C, Parker GJ, Logue JP, Hutchinson CE (2004) Prostate cancer: evaluation of vascular characteristics with dynamic contrast-enhanced T1-weighted MR imaging-initial experience. Radiology 233:709–715
Fütterer JJ, Engelbrecht MR, Jager GJ, Hartman RP, King BF, Hulsbergen-Van de Kaa CA, Witjes JA, Barentsz JO (2007) Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal-pelvic phased-array coils. Local staging accuracy of prostate cancer using endorectal coil MR imaging. Eur Radiol 17:1055–1065
Sella T, Schwartz LH, Swindle PW, Onyebuchi CN, Scardino PT, Scher HI, Hricak H (2004) Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 231(2):379–385
Wasserman NF, Kapoor DA, Hildebrandt WC, Zhang G, Born KM, Eppel SM, Reddy PK (1992) Transrectal US in evaluation of patients after radical prostatectomy. Part I. Normal postoperative anatomy. Radiology 185:361–366
Wasserman NF, Reddy PK (1993) Use of transrectal ultrasound in follow-up of postradical prostatectomy. Urology 41(1 Suppl):52–56
Janoff DM, Parra RO (2005) Contemporary appraisal of radical perineal prostatectomy. J Urol 173:1863–1870
Lance RS, Freidrichs PA, Kane C, Powell CR, Pulos E, Moul JW, McLeod DG, Cornum RL, Brantley Thrasher J (2001) A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group. BJU Int 87:61–65
Ahlering TE, Skarecky D, Lee D, Clayman RV (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170(5):1738–1741
Le CQ, Gettman MT (2006) Laparoscopic and robotic radical prostatectomy. Expert Rev Anticancer Ther 6(7):1003–1011
Sella T, Schwartz LH, Hricak H (2006) Retained seminal vesicles after radical prostatectomy: frequency, MRI characteristics, and clinical relevance. AJR Am J Roentgenol 186:539–546
Colombo T, Augustin H, Breinl E, Schips L, Hubmer G (1997) The use of polydimethylsiloxane in the treatment of incontinence after radical prostatectomy. Br J Urol 80:923–926
Hricak H, Williams RD, Spring DB, Moon KL Jr, Hedgcock MW, Watson RA, Crooks LE (1983) Anatomy and pathology of the male pelvis by magnetic resonance imaging. AJR Am J Roentgenol 141(6):1101–1110
Author information
Authors and Affiliations
Corresponding author
Additional information
No grant was applied for or received in the production of this work.
Rights and permissions
About this article
Cite this article
Allen, S.D., Thompson, A. & Sohaib, S.A. The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging. Eur Radiol 18, 1281–1291 (2008). https://doi.org/10.1007/s00330-008-0867-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-008-0867-3