Anatomical Analysis of Prostate and Surrounding Structures: Points to Consider during Radical Retropubic Prostatectomy

Sang Eun Lee; Seok-Soo Byun; Sung Kyu Hong; Hak Jong Lee; Yong June Kim; In Ho Chang; Myung Chul Gill

doi:10.4111/kju.2006.47.6.568

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Lee, Byun, Hong, Lee, Kim, Chang, and Gill: Anatomical Analysis of Prostate and Surrounding Structures: Points to Consider during Radical Retropubic Prostatectomy

Original Article

Korean J Urol 2006;47(6):568-577.

Published online: 18 December 2006

DOI: https://doi.org/10.4111/kju.2006.47.6.568

Anatomical Analysis of Prostate and Surrounding Structures: Points to Consider during Radical Retropubic Prostatectomy

Sang Eun Lee, Seok-Soo Byun, Sung Kyu Hong, Hak Jong Lee^1,, Yong June Kim, In Ho Chang, Myung Chul Gill

¹Radiology/Seoul National University Bundang Hospital, Seongnam, Korea

²From the Departments of Urology

Corresponding Author: Lee Sang-eun Department of Urology, Seoul National University Bundang Hospital Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 300 ? 463-707 TEL: 031-787-7341 FAX: 031-787-4057 E-mail: selee@snubh.org

Received 26 January 2006 Accepted 5 February 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To investigate the prevalences of anatomical variations regarding prostate and its surrounding structures, and also the intra- and postoperative effects of such anatomical variations in performing radical retropubic prostatectomy (RRP).

Materials and Methods:

A retrospective analysis of 156 patients who received RRP for prostate cancer was performed. Patients’ records including the results preoperative radiologic evaluations were reviewed. For our analysis, patients were grouped according to the anatomical variations relevant to prostate and surrounding structures shown on preoperative radiographs. Also, patients were interviewed via telephone as needed.

Results:

Prostate volume (mean: 41.4ml) measured from preoperative transrectal ultrasound correlated with estimated blood loss (EBL) during RRP (p=0.029). Interspinous diameter (mean: 1.69cm) measured on axial image of preoperative magnetic resonance imaging (MRI) was observed to be inversely correlated with operative time (p=0.010). And, patients with box-shaped deep dorsal vein (as demonstrated on axial view of MRI; 15.3%) were observed to have significantly less EBL during RRP (p=0.030). Also, EBL was significantly higher (p=0.013) for patients in which anterior portion of prostatic apex appeared to overlap and obscure membranous urethra (62.8%). Meanwhile, absence of the distal protrusion of apical region (21.8%) was observed to be associated with early (within 3 postoperative months) recovery of urinary continence (p=0.014).

Conclusions:

Our results suggest that various anatomical variations regarding prostate and its surrounding structure may exist as herein presented, and also that they may indeed have significant effects on both intra- and postoperative course regarding RRPs. Variations in the shape of prostatic apex may be significantly associated with recovery of continence after RRPs. (Korean J Urol 2006;47:568-577)

Keywords: Prostatic neoplasms, Prostatectomy, retropubic, Anatomy

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Fig. 1.

Greatest diameter of dorsal vein is measured on axial image of Tl-weighted magnetic resonance imaging.

Fig. 2.

Greatest diameter of membranous urethra is measured on axial image of T2-weighted magnetic resonance imaging.

Fig. 3.

Membranous urethral length is measured on coronal image of T2-weighted magnetic resonance imaging.

Fig. 4.

Variable shapes of dorsal vein demonstrated on axial image of magnetic resonance imaging.

Fig. 5.

Variable shapes of prostate demonstrated on midsagittal image of magnetic resonance imaging.

Table 1.

Patient characteristics

Mean age (years) ± SEM	65.9+0.5
Mean serum prostate specific antigen (ng/ml) ± SEM	10.8±1.5
No. serum prostate specific antigen (ng/ml) (%)
>4.0	25 (16.0)
4.0-9.9	81 (51.9)
≥10.0	50 (32.1)
No. Gleason sum (%)
6	48 (30.8)
7	96 (61.5)
8	4 (2.6)
9	8(5.1)
No. pathological stage (%)
T2a	37 (23.7)
T2b	1 (0.6)
T2c	80 (51.3)
T3a	15 (9.6)
T3b	13 (8.3)
T3c	2(1.3)
T4	8(5.1)

Table 2.

Association of various factors with blood loss during radical retropubic prostatectomy on multivariate analysis

	Odds ratio (95% CI)	p-value
Patient's age	0.98 (0.96-1.01)	0.391
Body mass index	1.54 (0.95-2.48)	0.077
Preop. PSA	0.93 (0.36-2.42)	0.887
Prostate volume	2.71 (1.13-6.47)	0.025
Operation time	3.24(1.53-6.89)	0.002
Gleason score	0.99 (0.96-1.03)	0.624
Pathologic stage	1.00(1.00-1.01)	0.202
Prostate shape (sagittal image)	0.70 (0.47-1.06)	0.081
Interspinous diameter	1.15 (0.78-1.67)	0.490

PSA: prostate-specific antigen, CI: confidence interval

Table 3.

Association of various factors with early recovery of continence following radical retropubic prostatectomy on multivariate analysis

	Odds ratio (95% CI)	p-value
Patient's age	1.27 (0.72-2.25)	0.410
Body mass index	1.12(0.81-1.55)	0.492
Baseline IPSS	1.02 (0.62-1.68)	0.926
Prostate volume	2.38 (0.75-7.52)	0.139
Estimated blood loss	0.99 (0.96-1.04)	0.978
Nerve sparing (unilateral or bilateral)	0.53 (0.94-2.95)	0.465
Gleason score	0.99 (0.91-1.08)	0.696
Length of membranous urethra	2.81 (0.95-8.34)	0.063
Cross sectional diameter of membranous urethra	2.85 (0.95-8.56)	0.061
Prostate shape (sagittal image)	3.71 (1.23-11.18)	0.019
Interspinous diameter	0.53 (0.88-3.18)	0.529

IPSS: International Prostate Symptom Score, CI: confidence interval

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