Anatomy of radical prostatectomy as defined by magnetic resonance imaging

Robert P. Myers, Donald R. Cahill, Richard M. Devine, Bernard Francis King

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Purpose: We examined and defined anatomical structures relevant to radical prostatectomy using magnetic resonance imaging. Materials and Methods: Before radical prostatectomy, 15 men underwent high-resolution magnetic resonance imaging studies of their pelvic floors (fast spin echo, T2 weighting of 3- to 4-mm. contiguous or overlapping slices) in axial, coronal, and sagittal planes. Results: Pubovesical ligaments, rather than the commonly reported puboprostatic ligaments, were observed attaching the bladder- prostate unit to the pubis. We suggest that the part of the urethra that extends from the apex of the prostate to the bulb of the penis, which is surrounded by the striated sphincter, should be termed the sphincteric urethra rather than the membranous urethra. Further, we found no evidence that supports the traditional concept of a urogenital diaphragm. The lower part of the striated urethral sphincter was flanked on its sides by the anterior recesses of the ischioanal fossae. The portion of the levator ani, which we have termed the puboanalis sling, flanked the apex of the prostate. The most anteromedial portion of this sling inserts into the perineal body and should be termed the puboperinealis. The terminal part of the gastrointestinal tract (the part continued beyond the levator ani) should be termed the anal canal, not the rectum, as used frequently in the urologic literature. Therefore, the initial plane of dissection in radical perineal prostatectomy passes along the anterior portion of the anal canal, not the rectum. Conclusion: We used magnetic resonance imaging to study male pelvic floor and perineal anatomy without the artifact of dissection. This study allowed us to devise a more precise nomenclature with respect to radical prostatectomy and, in so doing, to provide a better understanding of both the retropubic and the perineal operations.

Original languageEnglish (US)
Pages (from-to)2148-2158
Number of pages11
JournalJournal of Urology
Volume159
Issue number6
StatePublished - Jun 1998

Fingerprint

Anal Canal
Urethra
Prostatectomy
Anatomy
Magnetic Resonance Imaging
Prostate
Pelvic Floor
Ligaments
Rectum
Dissection
Pubic Bone
Penis
Diaphragm
Terminology
Artifacts
Gastrointestinal Tract
Urinary Bladder

Keywords

  • Anatomy
  • Magnetic resonance imaging
  • Pelvis
  • Perineum
  • Prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Myers, R. P., Cahill, D. R., Devine, R. M., & King, B. F. (1998). Anatomy of radical prostatectomy as defined by magnetic resonance imaging. Journal of Urology, 159(6), 2148-2158.

Anatomy of radical prostatectomy as defined by magnetic resonance imaging. / Myers, Robert P.; Cahill, Donald R.; Devine, Richard M.; King, Bernard Francis.

In: Journal of Urology, Vol. 159, No. 6, 06.1998, p. 2148-2158.

Research output: Contribution to journalArticle

Myers, RP, Cahill, DR, Devine, RM & King, BF 1998, 'Anatomy of radical prostatectomy as defined by magnetic resonance imaging', Journal of Urology, vol. 159, no. 6, pp. 2148-2158.
Myers, Robert P. ; Cahill, Donald R. ; Devine, Richard M. ; King, Bernard Francis. / Anatomy of radical prostatectomy as defined by magnetic resonance imaging. In: Journal of Urology. 1998 ; Vol. 159, No. 6. pp. 2148-2158.
@article{2f4ee876ac344e31a5dc8c9f217569f2,
title = "Anatomy of radical prostatectomy as defined by magnetic resonance imaging",
abstract = "Purpose: We examined and defined anatomical structures relevant to radical prostatectomy using magnetic resonance imaging. Materials and Methods: Before radical prostatectomy, 15 men underwent high-resolution magnetic resonance imaging studies of their pelvic floors (fast spin echo, T2 weighting of 3- to 4-mm. contiguous or overlapping slices) in axial, coronal, and sagittal planes. Results: Pubovesical ligaments, rather than the commonly reported puboprostatic ligaments, were observed attaching the bladder- prostate unit to the pubis. We suggest that the part of the urethra that extends from the apex of the prostate to the bulb of the penis, which is surrounded by the striated sphincter, should be termed the sphincteric urethra rather than the membranous urethra. Further, we found no evidence that supports the traditional concept of a urogenital diaphragm. The lower part of the striated urethral sphincter was flanked on its sides by the anterior recesses of the ischioanal fossae. The portion of the levator ani, which we have termed the puboanalis sling, flanked the apex of the prostate. The most anteromedial portion of this sling inserts into the perineal body and should be termed the puboperinealis. The terminal part of the gastrointestinal tract (the part continued beyond the levator ani) should be termed the anal canal, not the rectum, as used frequently in the urologic literature. Therefore, the initial plane of dissection in radical perineal prostatectomy passes along the anterior portion of the anal canal, not the rectum. Conclusion: We used magnetic resonance imaging to study male pelvic floor and perineal anatomy without the artifact of dissection. This study allowed us to devise a more precise nomenclature with respect to radical prostatectomy and, in so doing, to provide a better understanding of both the retropubic and the perineal operations.",
keywords = "Anatomy, Magnetic resonance imaging, Pelvis, Perineum, Prostatectomy",
author = "Myers, {Robert P.} and Cahill, {Donald R.} and Devine, {Richard M.} and King, {Bernard Francis}",
year = "1998",
month = "6",
language = "English (US)",
volume = "159",
pages = "2148--2158",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Anatomy of radical prostatectomy as defined by magnetic resonance imaging

AU - Myers, Robert P.

AU - Cahill, Donald R.

AU - Devine, Richard M.

AU - King, Bernard Francis

PY - 1998/6

Y1 - 1998/6

N2 - Purpose: We examined and defined anatomical structures relevant to radical prostatectomy using magnetic resonance imaging. Materials and Methods: Before radical prostatectomy, 15 men underwent high-resolution magnetic resonance imaging studies of their pelvic floors (fast spin echo, T2 weighting of 3- to 4-mm. contiguous or overlapping slices) in axial, coronal, and sagittal planes. Results: Pubovesical ligaments, rather than the commonly reported puboprostatic ligaments, were observed attaching the bladder- prostate unit to the pubis. We suggest that the part of the urethra that extends from the apex of the prostate to the bulb of the penis, which is surrounded by the striated sphincter, should be termed the sphincteric urethra rather than the membranous urethra. Further, we found no evidence that supports the traditional concept of a urogenital diaphragm. The lower part of the striated urethral sphincter was flanked on its sides by the anterior recesses of the ischioanal fossae. The portion of the levator ani, which we have termed the puboanalis sling, flanked the apex of the prostate. The most anteromedial portion of this sling inserts into the perineal body and should be termed the puboperinealis. The terminal part of the gastrointestinal tract (the part continued beyond the levator ani) should be termed the anal canal, not the rectum, as used frequently in the urologic literature. Therefore, the initial plane of dissection in radical perineal prostatectomy passes along the anterior portion of the anal canal, not the rectum. Conclusion: We used magnetic resonance imaging to study male pelvic floor and perineal anatomy without the artifact of dissection. This study allowed us to devise a more precise nomenclature with respect to radical prostatectomy and, in so doing, to provide a better understanding of both the retropubic and the perineal operations.

AB - Purpose: We examined and defined anatomical structures relevant to radical prostatectomy using magnetic resonance imaging. Materials and Methods: Before radical prostatectomy, 15 men underwent high-resolution magnetic resonance imaging studies of their pelvic floors (fast spin echo, T2 weighting of 3- to 4-mm. contiguous or overlapping slices) in axial, coronal, and sagittal planes. Results: Pubovesical ligaments, rather than the commonly reported puboprostatic ligaments, were observed attaching the bladder- prostate unit to the pubis. We suggest that the part of the urethra that extends from the apex of the prostate to the bulb of the penis, which is surrounded by the striated sphincter, should be termed the sphincteric urethra rather than the membranous urethra. Further, we found no evidence that supports the traditional concept of a urogenital diaphragm. The lower part of the striated urethral sphincter was flanked on its sides by the anterior recesses of the ischioanal fossae. The portion of the levator ani, which we have termed the puboanalis sling, flanked the apex of the prostate. The most anteromedial portion of this sling inserts into the perineal body and should be termed the puboperinealis. The terminal part of the gastrointestinal tract (the part continued beyond the levator ani) should be termed the anal canal, not the rectum, as used frequently in the urologic literature. Therefore, the initial plane of dissection in radical perineal prostatectomy passes along the anterior portion of the anal canal, not the rectum. Conclusion: We used magnetic resonance imaging to study male pelvic floor and perineal anatomy without the artifact of dissection. This study allowed us to devise a more precise nomenclature with respect to radical prostatectomy and, in so doing, to provide a better understanding of both the retropubic and the perineal operations.

KW - Anatomy

KW - Magnetic resonance imaging

KW - Pelvis

KW - Perineum

KW - Prostatectomy

UR - http://www.scopus.com/inward/record.url?scp=0032415448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032415448&partnerID=8YFLogxK

M3 - Article

C2 - 9598561

AN - SCOPUS:0032415448

VL - 159

SP - 2148

EP - 2158

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -