Clinical Anatomy of the Puboprostatic Ligament for the Safe Guidance for the Prostate Surgery

Abstract

OBJECTIVE To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

“…Recent findings, derived from human cadaveric studies, indicate that PV/PPL originates both from the visceral endopelvic fascia and the detrusor apron ( 35 ). Choi et al observed in a human cadaveric study ( n = 31) that PPLs were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%) prevalent ( 39 ). The authors postulate that bilateral double PPLs are likely to result in urogenital competence ( 39 ).…”

“…Choi et al observed in a human cadaveric study ( n = 31) that PPLs were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%) prevalent ( 39 ). The authors postulate that bilateral double PPLs are likely to result in urogenital competence ( 39 ). Due to the close relationship to the DVC and anterior bladder, identification of the PPL is easily appreciated in small/normal-sized prostates.…”