Stolzenburg Jens-Uwe, Schwalenberg Thilo, Horn Lars-Christian, Neuhaus Jochen, Constantinides Costantinos, Liatsikos Evangelos N
Department of Urology, University of Leipzig, Leipzig, Germany.
Eur Urol. 2007 Mar;51(3):629-39. doi: 10.1016/j.eururo.2006.11.012. Epub 2006 Nov 14.
In the present study, we review current literature and based on our experience, we present the anatomical landmarks of open and laparoscopic/endoscopic radical prostatectomy.
A thorough literature search was performed with the Medline database on the anatomy and the nomenclature of the structures surrounding the prostate gland. The correct handling of puboprostatic ligaments, external urethral sphincter, prostatic fascias and neurovascular bundle is necessary for avoiding malfunction of the urogenital system after radical prostatectomy.
When evaluating new prostatectomy techniques, we should always take into account both clinical and final oncological outcomes. The present review adds further knowledge to the existing "postprostatectomy anatomical hazard" debate. It emphasizes upon the role of the puboprostatic ligaments and the course of the external urethral sphincter for urinary continence. When performing an intrafascial nerve sparing prostatectomy most urologists tend to approach as close to the prostatic capsula as possible, even though there is no concurrence regarding the nomenclature of the surrounding fascias and the course of the actual neurovascular bundles. After completion of an intrafascial technique the specimen does not contain any periprostatic tissue and thus the detection of pT3a disease is not feasible. This especially becomes problematic if the tumour reaches the resection margin.
Nerve sparing open and laparoscopic radical prostatectomy should aim in maintaining sexual function, recuperating early continence after surgery, without hindering the final oncological outcome to the procedure. Despite the different approaches for radical prostatectomy the key for better results is the understanding of the anatomy of the bladder neck and the urethra.
在本研究中，我们回顾了当前的文献，并根据我们的经验，介绍了开放性和腹腔镜/内镜下根治性前列腺切除术的解剖标志。
利用医学在线数据库（Medline）对前列腺周围结构的解剖和命名进行了全面的文献检索。正确处理耻骨前列腺韧带、尿道外括约肌、前列腺筋膜和神经血管束对于避免根治性前列腺切除术后泌尿生殖系统功能障碍至关重要。
在评估新的前列腺切除技术时，我们应始终兼顾临床和最终肿瘤学结果。本综述为现有的“前列腺切除术后解剖风险”辩论增添了更多知识。它强调了耻骨前列腺韧带的作用以及尿道外括约肌在尿失禁方面的走行。在进行筋膜内保留神经的前列腺切除术时，大多数泌尿外科医生倾向于尽可能靠近前列腺包膜操作，尽管对于周围筋膜的命名以及实际神经血管束的走行尚无共识。完成筋膜内技术后，标本不包含任何前列腺周围组织，因此检测pT3a期疾病是不可行的。如果肿瘤累及切除边缘，这尤其会成为问题。
保留神经的开放性和腹腔镜根治性前列腺切除术应旨在维持性功能，术后尽早恢复控尿能力，同时不妨碍手术的最终肿瘤学结果。尽管根治性前列腺切除术有不同的手术方式，但取得更好结果的关键在于了解膀胱颈和尿道的解剖结构。
