Pelvic Fasciae in Urology

Abstract

Despite the vast literature on pelvic fascia, there is confusion over the periprostatic structures and their nomenclature, including their orientation, the neurovascular bundles and the existence of the prostatic 'capsule'. In this review, we seek to clarify some of these issues. Review of published medical literature relating to the anatomy of the pelvic fascia including a Pubmed search using the terms - pelvic fascia, Denonvilliers' fascia, prostate capsule, neurovascular bundle of Walsh, puboprostatic ligament and the detrusor apron. The findings of the study were as follows: 1. The 'capsule' of the prostate does not exist. Rather, the fibromuscular band surrounding the prostate forms an integral part of the gland. 2. The prostate is surrounded by fascial structures - anteriorly/anterolaterally by the prostatic fascia and posteriorly by the Denonvilliers' fascia. Laterally, the prostatic fascia merges with the endopelvic fascia. 3. The posterior longitudinal fascia of the detrusor comprises a 'posterior layer' of the detrusor apron, extending from the bladder neck to the prostate base. 4. The neurovascular structures tend to be located posterolaterally, but may not always form a bundle. A significant proportion of fibres may lie away from the main nerve structures, along the lateral/posterior aspects of the prostate.