Anatomy of the Prostate

Laucirica, Oscar; Catalá, Violeta; Vilanova, Joan C.

doi:10.1007/978-3-319-61786-2_2

Cited by 2 publications

(7 citation statements)

References 22 publications

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“…Thus, with regard to urinary continence, three factors are seen to be of importance (Fig. 9): 3,12–17,19 The extrinsic or active factor of urinary continence: the puborectalis and MsPP, the most ventromedial fascicles of the levator ani muscle, are responsible for the abrupt interruption of micturition (Figs 1,10). They consist of type II striated muscle fibers and are innervated by the pudendal nerve. The intrinsic or passive factor: the IUS and EUS, which require a certain “muscular tone” to prevent “constant dripping.” The last one (EUS) comprises striated muscle fiber (mostly type I) innervated by the pudendal nerve, through its extrapelvic and intrapelvic fibers.The IUS is innervated by the corpus spongiosum nerves (neurovegetative innervation; Figs 1,10).…”

Section: Discussionmentioning

confidence: 99%

“…Innervation runs through the breadth of the periprostatic fascia, most particularly along its lateral facets, which make up the so‐called neurovascular bundles, responsible not only for erection, but also for playing a significant role in the preservation of urinary continence (Figs 1,10). 12–14 …”

Section: Discussionmentioning

confidence: 99%

“…During radical prostatectomy, to a greater or lesser extent, we cause damage to these three factors and this in turn gives rise to PUI, representing a significant loss in the quality of life for these patients 12–15 …”

Section: Discussionmentioning

confidence: 99%

“…We propose a straightforward surgical technique deployed in two stages (DPPM and RMD), 14 via a classical retropubic approach through the pelvic subperitoneal space and applicable to any of the three standard techniques (open, laparoscopic or robot‐assisted surgery). The goal of the technique is to preserve the aforementioned neuroanatomical structures, all of which are involved in maintaining male urinary continence.…”

Section: Discussionmentioning

confidence: 99%

“…In most cases, urinary incontinence is caused by damage, either to the intrinsic or extrinsic muscle systems that play an active role in urinary continence, as well as damage to the vascular/nerve pedicles involved in the process 3,12–18 …”

Section: Introductionmentioning

confidence: 99%

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Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

et al. 2020

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Abbreviations & Acronyms AFMS = anterior fibromuscular stroma BCR = biochemical recurrence BMI = body mass index CZ = central zone DPPM = dissection of puboperinealis and puborectalis muscle DVP = dorsal vein complex of the penis ECE = extracapsular extension EUS = external urethral sphincter ICIQ-SF = International Consultation on Incontinence Questionnaire Short-Form IQR = interquartile range IUS = internal urethral sphincter LRP = laparoscopic radical prostatectomy MRI = magnetic resonance imaging MsPP = puboperinealis muscle NVai = neurovegetative afferent innervation NVBP = neurovascular bundle preservation PA = apex of the prostate PDE5 = phosphodiesterase 5 inhibitors PSA = prostate-specific antigen PSM = positive surgical margins PUI = postoperative urinary incontinence PZ = peripheral zone RMD = rhabdomyo-dissection SB = spongiosum bulb of urethra TZ = transition zone VVSS = seminal vesiclesObjectives: To describe our surgical technique of "muscle-sparing" laparoscopic radical prostatectomy and to review relevant anatomical landmarks during the procedure. Methods: This was a prospective non-controlled case series of 120 consecutive patients who underwent laparoscopic radical prostatectomy, always carried out by the same surgeon (OL). The median follow-up period was 33 months. Dissection of the puboperinealis and puborectalis muscle consists of the precise dissection of the puborectalis and puboperinealis muscles from the periprostatic fascia. Rhabdomyodissection consists of an approach that spares the external urethral sphincter from the ventral surface of the prostate and membranous urethra. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications and outcomes of urinary continence were assessed. A descriptive statistical analysis was carried out. Results: Continence rates were 70.8%, 83.3% and 92.5%, at 0-2, 3-4 and 5-8 weeks after removal of the urethral catheter, respectively; 96.6% and 98.3% at 6 and 12 months after surgery. The positive surgical margin rate associated with rhabdomyo-dissection was 8.3%. Conclusions: Laparoscopic radical prostatectomy with dissection of the puboperinealis and puborectalis muscle, and rhabdomyo-dissection is an oncologically safe procedure, associated with very early recovery urinary continence in most patients. It is a technique that can be applied in most cases, as long as there is no invasion of the ventral side of the prostate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

et al. 2020

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Outcome of Early Removal of Urinary Catheter after Transurethral Resection of Prostate (TUR-P)

Zulfiqar¹,

Ahmed²,

Amir³

et al. 2021

J. Bahria Univ. Med. Dent. Coll.

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Objective: To determine the outcome of early removal of urinary catheter, and predict the possibility of TUR-P as a day care surgery, in terms of reduced hospital stay. Study Design & Setting: It was a cross sectional study design with non-probability sampling conducted at Department of Urology, Rawalpindi medical college from January to July 2017. Methodology: Total 190 patients fulfilled inclusion and exclusion criteria were selected for the study. Patient underwent TUR-P followed by catheter irrigation. Time was noted as ‘zero’ hour. The color of the effluent was grossly monitored. When the effluent became clear the catheter was removed and time noted. After successful voiding, patient was discharged and time noted. Success is if the duration from time ‘zero’ hours to catheter removal is within 24 hours and duration of hospital stay is within 36 hours. A time line greater is considered to be failure. Data analysis was done using SPSS version 15.0. For quantitative variables like age, time of catherization and hospital stay, median and standard deviation was calculated. For qualitative variables like success, frequency and percentages were calculated. Groups and tables were made to present the data. Results: Mean duration of catherization after TUR-P is 9.67 ± 2.36 (hrs. min). Hospital stay was 26.73 ± 6.24 hours. Frequency and percentage of successful outcome was 152 out of 190 patients and 82.6% respectively. Conclusion: Our study favors that in selected patients TUR-P can be performed with shorter hospital stay with minimal postoperative complications. This will benefit the patient in terms of reducing comorbids and considerable departmental financial savings

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Anatomy of the Prostate

Cited by 2 publications

References 22 publications

Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

Outcome of Early Removal of Urinary Catheter after Transurethral Resection of Prostate (TUR-P)

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