The Role of the Prostatic Vasculature as a Landmark for Nerve Sparing During Robot-Assisted Radical Prostatectomy

Patel, Vipul; Schatloff, Oscar; Chauhan, Sanket; Sivaraman, Ananthakrishnan; Valéro, R.; Coelho, Rafael F.; Rocco, Bernardo; Palmer, Kenneth J.; Kameh, Darian

doi:10.1016/j.eururo.2011.12.047

Cited by 78 publications

(46 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The prostatic fascia is a multilayered connective tissue that comprises collagenous fibers, fat tissues, nerves and blood vessels. Laterally it fuses with the endopelvic fascia [12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

“…Preservation of the fascia helps to protect the levator ani muscle, rhabdosphincter and pudendal nerve branches to the rhabdosphincter 3,5,15 . The current consensus, therefore, is that the neurovascular structures are located in the postero-lateral region of the prostate, at the confluence of Denonvilliers' fascia with the endopelvic and pararectal fascia [12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

“…The parietal and visceral endopelvic fascia is fused on the lateral side of the prostate and bladder. In this fusion, the levator fascia approaches the prostate and then turns back laterally [12][13][14] . This fusion site is sometimes recognized as a whitish line and is called the arcus tendineus fascia pelvis.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

Julio

Costa

et al. 2015

Acta Cir. Bras.

View full text Add to dashboard Cite

PURPOSE:To evaluate the structure of the endopelvic fascia in prostates of different weights. METHODS:We studied 10 patients with BPH (prostates>90g); 10 patients with prostate adenocarcinoma (PAC) (prostates<60g) and five young male cadavers (control group). During the surgery a small sample of endopelvic fascia was obtained. We analyzed elastic fibers, collagen and smooth muscle. The stereological analysis was done with the Image Pro and Image J programs. Means were statistically compared using the one-way ANOVA with the Bonferroni test and a p<0.05 was considered statistically significant. RESULTS:The mean of the prostate weight was 122 g in BPH patients, 53.1g in PAC patients and 18.6g in control group. Quantitative analysis documented that there are no differences (p=0.19) in Vv of elastic fibers and in Vv of type III collagen (p=0.88) between the three groups. There was a significant difference (p=0<0.0001) in the quantification of SMC in patients with prostates >90g (mean=9.61%) when compared to patients with prostates <60g (mean=17.92%) and with the control group (mean=33.35%).CONCLUSION: There are differences in endopelvic fascia structure in prostates>90g, which can be an additional factor for preoperatory evaluation of radical prostatectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

Julio

Costa

et al. 2015

Acta Cir. Bras.

View full text Add to dashboard Cite

show abstract

“…In 2011, Patel VR et al performed a retrospective video analysis of 133 consecutive patients who underwent RARP with nerve sparing performed using a retrograde, antegrade, or combined approach [ 28 ].…”

Section: The Role Of the Prostatic Vasculature As A Landmark For Nervmentioning

confidence: 99%

Robot-Assisted Radical Prostatectomy

Rocco

Coelho

Cozzi

et al. 2014

Minimally Invasive Urology

Self Cite

View full text Add to dashboard Cite

In the field of oncologic urologic surgery, robot-assisted radical prostatectomy (RARP) represents the main application of the robotic approach. RARP is currently the leading urologic use of the da Vinci system, and more than 80 % of the radical prostatectomies performed in the USA in 2011 were carried out by robot-assisted surgery. Indications for RARP are the same with those for radical retropubic prostatectomy (RRP), and RARP has also been described as a salvage surgical treatment after radiotherapy (RT), brachytherapy, and high-intensity focused ultrasound. Under an oncological point of view, RARP offers at least the same results of RRP also in higher-risk patients. Extended lymph node dissection yielding a reasonably high number of lymph nodes is feasible during RARP. The mean complication rate of RARP is 9 % (range, 3–26 %). Twelve-month urinary incontinence rates after RARP range from 4 to 31 %, with significant advantage in favor of RARP in comparison with RRP and laparoscopic radical prostatectomy. RARP is associated with an incidence of 12- and 24-month erectile dysfunction ranging from 10 to 46 % and from 6 to 37 %, respectively. A significant advantage in favor of RARP in comparison with RRP in terms of 12 months’ potency rates has been observed. Concomitant good oncological, continence, and potency outcomes define the concept of “trifecta.”\ud This chapter presents the technique for RARP described by Patel, which introduces some differences from the standard laparoscopic and robotic technique described previously

show abstract

“…Vascular preservation techniques exist that might allow us to optimize the post-operative erectile function and to facilitate nerve preservation (Secin et al 2007;Patel et al 2012).…”

Section: Introductionmentioning

confidence: 99%

What is the origin of the arterial vascularization of the corpora cavernosa? A computer‐assisted anatomic dissection study

et al. 2013

View full text Add to dashboard Cite

The purpose of this study was to identify the microscopic arterial vascularization of the corpora cavernosa (CC) of the penis using computer-assisted anatomic dissection (CAAD), determine the contribution of the different penile arteries towards this vascularization, detail the nature of cavernospongiosum shunts, and locate the anastomoses between these different arteries. Tissue specimens were taken from five donors who donated their bodies to science. The specimens were fixed in 10% formalin and sliced into a series of five 5-lm sections at intervals of 200 lm. The first section was stained with hematoxylin-eosin or Masson's trichrome and the second with anti-protein S100. The cavernous artery of the penis is not the only source of arterial vascularization of the CC. In four of the five cases studied, we found two to four perforating branches arising from the dorsal arteries of the penis that join up with the cavernous artery of the penis or that are solely responsible for the vascularization of the distal third of the penis. The bulbo-urethral and urethral arteries are situated outside of the tunica albuginea of the corpus spongiosum on their lateral and dorsal sides. The anastomoses do not occur between the cavernous artery of the penis and the corpus spongiosum but between the cavernous artery of the penis and the urethral artery on the surface of the tunica albuginea. All of these arteries are accompanied by nerve branches. The CC were found to be vascularized by both cavernous and dorsal arteries of the penis. Intrapenile vascularization is organized around four arterial axes, which are anastomosed by multiple neurovascular shunts.

show abstract

The Role of the Prostatic Vasculature as a Landmark for Nerve Sparing During Robot-Assisted Radical Prostatectomy

Cited by 78 publications

References 16 publications

Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

Robot-Assisted Radical Prostatectomy

What is the origin of the arterial vascularization of the corpora cavernosa? A computer‐assisted anatomic dissection study

Contact Info

Product

Resources

About