Surgical anatomy of the puboprostatic complex with special reference to radical perineal prostatectomy

BJU Int. 2003 Nov;92(7):681-4. doi: 10.1046/j.1464-410x.2003.04489.x.


Objective: To investigate the retropubic space and attachments of the prostate and urethra, with special reference to radical perineal prostatectomy.

Materials and methods: Anatomical relationships were assessed intraoperatively in 60 patients, and in five cadavers after preparing the dorsal vein complex with coloured latex. Cross-sections of the area of interest were evaluated by microscopy.

Results: The puboprostatic (pubovesical) ligaments could be clearly distinguished from the median part of the puboprostatic complex continuous with the urethral suspensory mechanism. The dorsal vein complex is integrated into this fibromuscular attachment of the prostate and male urethra. During the perineal approach, dissection in this region follows the so-called avascular plane.

Conclusion: With this new insight into the anatomical relationships the nomenclature derived from radical retropubic prostatectomy could be mirrored. In radical perineal prostatectomy, both the urethral suspensory mechanism and the dorsal vein complex can be preserved.

MeSH terms

  • Humans
  • Ligaments / anatomy & histology
  • Male
  • Pelvis / anatomy & histology*
  • Prostate / anatomy & histology*
  • Prostatectomy*