A critical analysis of the current knowledge of surgical anatomy related to optimization of XXXX control and preservation of continence and erection in candidates for radical prostatectomy.

@entity5 @entity531
CONTEXT: Detailed knowledge of the anatomy of the prostate and adjacent tissues is mandatory during radical prostatectomy to ensure reliable oncologic and functional outcomes. OBJECTIVE: To review critically and to summarize the available literature on surgical anatomy of the prostate and adjacent structures involved in @entity5 control, erectile function, and urinary continence. EVIDENCE ACQUISITION: A search of the PubMed database was performed using the keywords radical prostatectomy, anatomy, @entity531 , fascia, pelvis, and sphincter. Relevant articles and textbook chapters were reviewed, analyzed, and summarized. EVIDENCE SYNTHESIS: Anatomy of the prostate and the adjacent tissues varies substantially. The fascia surrounding the prostate is multilayered, sometimes either fused with the prostate capsule or clearly separated from the capsule as a reflection of interindividual variations. The @entity531 ( @entity531 ) is situated between the fascial layers covering the prostate. The @entity531 is composed of numerous nerve fibers superimposed on a scaffold of veins, arteries, and variable amounts of adipose tissue surrounding almost the entire lateral and posterior surfaces of the prostate. The @entity531 is also in close, cage-like contact to the seminal vesicles. The external urethral sphincter is a complex structure in close anatomic and functional relationship to the pelvic floor, and its fragile innervation is in close association to the prostate apex. Finally, the shape and size of the prostate can significantly modify the anatomy of the @entity531 , the urethral sphincter, the dorsal vascular complex, and the pubovesical/puboprostatic ligaments. CONCLUSIONS: The surgical anatomy of the prostate and adjacent tissues involved in radical prostatectomy is complex. Precise knowledge of all relevant anatomic structures facilitates surgical orientation and dissection during radical prostatectomy and ideally translates into both superior rates of @entity5 control and improved functional outcomes postoperatively.
