Is the striated urethral sphincter at risk by standard suture ligation of the dorsal vascular complex in radical prostatectomy? An anatomic study.

Abstract

To perform an anatomic study of the dorsal vascular complex (DVC) and the underlying striated sphincter (SS) to investigate if the SS might be harmed by standard suture ligation in radical prostatectomy. Transverse wholemount serial sections were created from adult male autopsy cadavers. The total surface area of the DVC and the SS were measured at the prostatic apex and 5 mm distal to it using the ImageJ software. The dorsal boundary of the DVC and the ventral border of the SS were defined digitally. The percentage of the surface area of the SS that would be entrapped by a ligation stitch including the entire DVC was then calculated. In addition, 3-dimensional reconstruction of the lower urinary tract was performed using the SURFdriver software. Five adult male cadavers were investigated. The mean surface area of the SS was 116.1 ± 80.7 and 78.0 ± 63.3 mm(2) at the apex and 5 mm distal to it, respectively. On average, 36.7% (42.6 ± 41.4 mm(2)) and 29.9% (23.3 ± 13.6 mm(2)) of the surface area of the SS were located ventral to the lower boundary of the DVC at the apex and 5 mm distal to it, respectively, and would thus be entrapped by standard suture ligation. Our anatomic findings suggest that standard suture ligation of the DVC is associated with the risk of affecting sphincter tissue. Our study is in accordance with recent clinical studies showing improved early postoperative continence rates by primary transection of the DVC followed by selective suture ligation.