A novel technique for approaching the endopelvic fascia in retropubic radical prostatectomy, based on an anatomical study of fixed and fresh cadavers

Abstract

achieve continence in 23 consecutive patients who had a radical retropubic prostatectomy using the new technique. RESULTSSectional macroscopic observation depicted the fascia of the levator ani as a definite structure adherent to but not fused with the lateral pelvic fascia. The thin fascia overlying the levator ani fascia and lateral pelvic fascia represented the true endopelvic fascia. Microscopically, the lower part of the fascia of the levator ani was rich in smooth muscle, which interdigitated with the framework of the rhabdosphincter. In fresh cadavers, the levator ani muscle was removed laterally still covered by its fascia, without visualizing the muscle fibres. Small branches from the pudendal nerve entered the rhabdosphincter. The mean ( SD , range) distance from the lowest point of the endopelvic fascia to the point where the sphincteric branch entered the rhabdosphincter was 5.5 (1.8, 3-8) mm. The continence rate at 1, 3, 6 and 9 months after surgery using the new technique was 44%, 83%, 96% and 100%, respectively. CONCLUSIONSPreserving the fascia of the levator ani helps to protect the levator ani muscle, rhabdosphincter and pudendal nerve branches to the rhabdosphincter. In retropubic radical prostatectomy, this anatomical approach to the endopelvic fascia should preserve or allow the earlier recovery of urinary continence. KEYWORDS endopelvic fascia, fresh cadaver, urinary incontinence OBJECTIVETo present the anatomical basis and details of a technique for an approach to the endopelvic fascia devised to preserve urinary continence.

Surgical Anatomy of Intrapelvic Fasciae and Vesico-Uterine Ligament in Nerve-Sparing Radical Hysterectomy with Fresh Cadaver Dissections

“…In our cadavers, the superior, or intrapelvic, surface of the levator ani was covered by a definite parietal fascia that corresponds with the "endopelvic fascia" cited in urology (Hinman 1993;Takenaka et al 2005). In sections across the cervix uteri, the pelvic plexus was identified as one to three plate-like condensations of nerve elements (Fig.…”

Revisiting anatomical landmarks of cadaveric nerve-sparing radical prostatectomy in accordance to Terminologia Anatomica

“…This fascia is referred to as the endopelvic fascia (EPF) by some authors. [18,19] It has two compartments, which are parietal and visceral. The surgeon gains full access to the prostate only after incision of the endopelvic fascia at the fusion between the parietal and visceral component of the antero-lateral corner of the prostate.…”

“…The related structures with endopelvic fascia (parietal pelvic fascia) are the fascia of the levator ani muscle and lateral pelvic fascia, which is located at the ventral and lateral surface of the prostate under the EPF and extends in a posterior direction to cover also the neurovascular bundle (NVB) and the rectum. [14,18,22] EPF is attached to the pubic bone and forms the puboprostatic ligaments (PPLs). The incision of EPF during intrafascial dissection takes place only ventrally and medially to the PPLs.…”

Controversias en la anatomía quirúrgica prostática: Revisión de la literatura

“…Takenaka et al 23 , utiliza el término fascia endopélvica para referirse a la fascia parietal y a la fascia visceral. En sus estudios anatómicos observaron que la fascia del elevador del ano como una estructura independiente adherida a la unión uretro-prostática.…”