Surgical Anatomy of the Prostate for Radical Prostatectomy

Abstract

Surgical anatomy description for radical prostatectomy includes anatomic points and practical surgical options of dissection. Clear understanding of the prostate boundaries and periprostatic fascia helps in identifying the various planes of surgical dissection and in communication between surgeons. The so-called prostatic capsule is made of transversely arranged fibromuscular stromal layers but at the apex, base, and bladder neck. Fascial surgical dissection involves two fascias: a single-layered parietal fascia (levator fascia) and an underlying multilayered fibrofatty visceral fascia that tethers the nerve and vascular bundles to the prostate. Surgical dissection for radical prostatectomy could be either extrafascial lateral to the parietal fascia or intrafascial, medial to the parietal fascia. During this intrafascial dissection which is necessary for nerve sparing, the surgeon may progress in a interfascial plane between the layers, in order to leave some layers of visceral fibrofatty sheath on the surgical specimen and to limit the risk of positive surgical margins. The surgeon may also progress along a endo-fascial plane, tearing some fibers off the so-called prostatic capsule which will, at this location, be bare of any prostatic visceral multilayered connective adipose fascia.