Skip to main content
SpringerLink
Log in
Book cover

Prostate Ultrasound pp 11–30Cite as

Applied Anatomy of the Male Pelvis

  • Chapter
  • First Online:

  • 1687 Accesses

Abstract

In this book chapter we combine our own experience in the operation theatre and dissection lab, with recent literature to give an up-to-date overview of the functional anatomy of the male pelvis.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

APA:

Accessory pudendal artery

DA:

Detrusor apron

DVC:

Dorsal vascular complex

EUS:

External urethral sphincter

FTAP:

Fascial tendinous arch of the pelvis

IPA:

Internal pudendal artery

IUS:

Internal urethral sphincter

LAF:

Levator ani fascia

NVB:

Neurovascular bundle

PF:

Prostatic fascia

PPF:

Peri-prostatic fascia

PPL:

Puboprostatic ligaments

PVL:

Pubovesical ligaments

SV:

Seminal vesicles

TURP:

Transurethral resection of the prostate

References

  1. Walsh PC. The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy. J Urol. 2007;177(5):1632–5.

    Article  PubMed  Google Scholar 

  2. Brooks JD. Anatomy of the lower urinary tract and male genitalia. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders Elsevier; 2007.

    Google Scholar 

  3. Ayala AG, Ro JY, Babaian R, Troncoso P, Grignon DJ. The prostatic capsule: does it exist? Its importance in the staging and treatment of prostatic carcinoma. Am J Surg Pathol. 1989;13(1):21–7.

    Article  CAS  PubMed  Google Scholar 

  4. Raychaudhuri B, Cahill D. Pelvic fasciae in urology. Ann R Coll Surg Engl. 2008;90(8):633–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. McNeal JE. Normal and pathologic anatomy of prostate. Urology. 1981;17 Suppl 3:11–6.

    CAS  PubMed  Google Scholar 

  6. Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010;57(2):179–92.

    Article  PubMed  Google Scholar 

  7. McNeal JE. The zonal anatomy of the prostate. Prostate. 1981;2(1):35–49.

    Article  CAS  PubMed  Google Scholar 

  8. Zlotta AR, Roumeguere T, Ravery V, Hoffmann P, Montorsi F, Turkeri L, et al. Is seminal vesicle ablation mandatory for all patients undergoing radical prostatectomy? A multivariate analysis on 1283 patients. Eur Urol. 2004;46(1):42–9.

    Article  PubMed  Google Scholar 

  9. Secin FP, Bianco FJ, Cronin A, Eastham JA, Scardino PT, Guillonneau B, et al. Is it necessary to remove the seminal vesicles completely at radical prostatectomy? Decision curve analysis of European Society of Urologic Oncology criteria. J Urol. 2009;181(2):609–13. discussion 14.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Stoker J. Anorectal and pelvic floor anatomy. Best Pract Res Clin Gastroenterol. 2009;23(4):463–75.

    Article  PubMed  Google Scholar 

  11. Burnett AL, Mostwin JL. In situ anatomical study of the male urethral sphincteric complex: relevance to continence preservation following major pelvic surgery. J Urol. 1998;160(4):1301–6.

    Article  CAS  PubMed  Google Scholar 

  12. Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179(5):1683–9.

    Article  PubMed  Google Scholar 

  13. Wallner C, Dabhoiwala NF, DeRuiter MC, Lamers WH. The anatomical components of urinary continence. Eur Urol. 2009;55(4):932–43.

    Article  PubMed  Google Scholar 

  14. Gudziak MR, McGuire EJ, Gormley EA. Urodynamic assessment of urethral sphincter function in post-prostatectomy incontinence. J Urol. 1996;156(3):1131–4. discussion 4–5.

    Article  CAS  PubMed  Google Scholar 

  15. Koraitim M, Sabry AA. Mechanism of continence after transpubic urethroplasty. Urology. 1986;27(2):187–90.

    Article  CAS  PubMed  Google Scholar 

  16. Koraitim MM, Atta MA, Fattah GA, Ismail HR. Mechanism of continence after repair of post-traumatic posterior urethral strictures. Urology. 2003;61(2):287–90.

    Article  CAS  PubMed  Google Scholar 

  17. Tokunaka S, Murakami U, Fujii H, Okamura K, Miyata M, Hashimoto H, et al. Coexistence of fast and slow myosin isozymes in human external urethral sphincter. A preliminary report. J Urol. 1987;138(3): 659–62.

    CAS  PubMed  Google Scholar 

  18. Elbadawi A, Mathews R, Light JK, Wheeler TM. Immunohistochemical and ultrastructural study of rhabdosphincter component of the prostatic capsule. J Urol. 1997;158(5):1819–28.

    Article  CAS  PubMed  Google Scholar 

  19. Myers RP. Practical surgical anatomy for radical prostatectomy. Urol Clin North Am. 2001;28(3):473–90.

    Article  CAS  PubMed  Google Scholar 

  20. Kiyoshima K, Yokomizo A, Yoshida T, Tomita K, Yonemasu H, Nakamura M, et al. Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol. 2004;34(8):463–8.

    Article  PubMed  Google Scholar 

  21. Costello AJ, Dowdle BW, Namdarian B, Pedersen J, Murphy DG. Immunohistochemical study of the cavernous nerves in the periprostatic region. BJU Int. 2011;107(8):1210–5.

    Article  PubMed  Google Scholar 

  22. Costello AJ, Brooks M, Cole OJ. Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004;94(7):1071–6.

    Article  PubMed  Google Scholar 

  23. Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg. 2000;87(10):1288–99.

    Article  CAS  PubMed  Google Scholar 

  24. Lindsey I, Warren B, Mortensen N. Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers’ fascia (Br J Surg 2004; 91: 121–123). Br J Surg. 2004;91(7):897.

    Article  CAS  PubMed  Google Scholar 

  25. Lindsey I, Warren BF, Mortensen NJ. Denonvilliers’ fascia lies anterior to the fascia propria and rectal dissection plane in total mesorectal excision. Dis Colon Rectum. 2005;48(1):37–42.

    Article  PubMed  Google Scholar 

  26. Myers RP. Detrusor apron, associated vascular plexus, and avascular plane: relevance to radical retropubic prostatectomy—anatomic and surgical commentary. Urology. 2002;59(4):472–9.

    Article  PubMed  Google Scholar 

  27. Myers RP, Goellner JR, Cahill DR. Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection. J Urol. 1987;138(3):543–50.

    CAS  PubMed  Google Scholar 

  28. Walsh PC. Radical prostatectomy, preservation of sexual function, cancer control. The controversy. Urol Clin North Am. 1987;14(4):663–73.

    CAS  PubMed  Google Scholar 

  29. Poore RE, McCullough DL, Jarow JP. Puboprostatic ligament sparing improves urinary continence after radical retropubic prostatectomy. Urology. 1998;51(1):67–72.

    Article  CAS  PubMed  Google Scholar 

  30. Asimakopoulos AD, Annino F, D’Orazio A, Pereira CF, Mugnier C, Hoepffner JL, et al. Complete periprostatic anatomy preservation during robot-assisted laparoscopic radical prostatectomy (RALP): the new pubovesical complex-sparing technique. Eur Urol. 2010;58(3):407–17.

    Article  PubMed  Google Scholar 

  31. Tewari AK, Bigelow K, Rao S, Takenaka A, El-Tabi N, Te A, et al. Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy. Urology. 2007;69(4):726–31.

    Article  PubMed  Google Scholar 

  32. Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, et al. Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol. 2007;51(3):648–57. discussion 57–8.

    Article  PubMed  Google Scholar 

  33. Dorschner W, Stolzenburg JU. A new theory of micturition and urinary continence based on histomorphological studies. 3. The two parts of the musculus sphincter urethrae: physiological importance for continence in rest and stress. Urol Int. 1994;52(4):185–8.

    Article  CAS  PubMed  Google Scholar 

  34. Rocco F, Carmignani L, Acquati P, Gadda F, Dell’Orto P, Rocco B, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006;175(6):2201–6.

    Article  CAS  PubMed  Google Scholar 

  35. Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC, Furtado A, et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol. 2012;23(11):1403–15.

    Article  PubMed  Google Scholar 

  36. Bilhim T, Tinto HR, Fernandes L, Martins Pisco J. Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol. 2012;15(4):276–85.

    Article  PubMed  Google Scholar 

  37. Carnevale FC, Antunes AA, da Motta Leal Filho JM, de Oliveira Cerri LM, Baroni RH, Marcelino AS, et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol. 2010;33(2):355–61.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Clegg EJ. The arterial supply of the human prostate and seminal vesicles. J Anat. 1955;89(2):209–16.

    CAS  PubMed Central  PubMed  Google Scholar 

  39. Pisco J, Campos Pinheiro L, Bilhim T, Duarte M, Rio Tinto H, Fernandes L, et al. Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology. 2013;266(2):668–77.

    Article  PubMed  Google Scholar 

  40. Fernandes L, Rio Tinto H, Pereira J, Duarte M, Bilhim T, Martins Pisco J. Prostatic arterial embolization: post-procedural follow-up. Tech Vasc Interv Radiol. 2012;15(4):294–9.

    Article  PubMed  Google Scholar 

  41. Secin FP, Karanikolas N, Touijer AK, Salamanca JI, Vickers AJ, Guillonneau B. Anatomy of accessory pudendal arteries in laparoscopic radical prostatectomy. J Urol. 2005;174(2):523–6. discussion 6.

    Article  PubMed  Google Scholar 

  42. Secin FP, Touijer K, Mulhall J, Guillonneau B. Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol. 2007;51(5):1229–35.

    Article  PubMed  Google Scholar 

  43. Garcia-Monaco R, Garategui L, Kizilevsky N, Peralta O, Rodriguez P, Palacios-Jaraquemada J. Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization. J Vasc Interv Radiol. 2014;25(2):315–22.

    Article  PubMed  Google Scholar 

  44. Power NE, Silberstein JL, Kulkarni GS, Laudone VP. The dorsal venous complex (DVC): dorsal venous or dorsal vasculature complex? Santorini’s plexus revisited. BJU Int. 2011;108(6):930–2.

    PubMed  Google Scholar 

  45. Reiner WG, Walsh PC. An anatomical approach to the surgical management of the dorsal vein and Santorini’s plexus during radical retropubic surgery. J Urol. 1979;121(2):198–200.

    CAS  PubMed  Google Scholar 

  46. Benoit G, Droupy S, Quillard J, Paradis V, Giuliano F. Supra and infralevator neurovascular pathways to the penile corpora cavernosa. J Anat. 1999;195(Pt 4):605–15.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Tewari A, Takenaka A, Mtui E, Horninger W, Peschel R, Bartsch G, et al. The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy. BJU Int. 2006;98(2):314–23.

    Article  PubMed  Google Scholar 

  48. Gosling JA, Dixon JS. The structure and innervation of smooth muscle in the wall of the bladder neck and proximal urethra. Br J Urol. 1975;47(5):549–58.

    Article  CAS  PubMed  Google Scholar 

  49. Akita K, Sakamoto H, Sato T. Origins and courses of the nervous branches to the male urethral sphincter. Surg Radiol Anat. 2003;25(5-6):387–92.

    Article  CAS  PubMed  Google Scholar 

  50. Narayan P, Konety B, Aslam K, Aboseif S, Blumenfeld W, Tanagho E. Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol. 1995;153(2):337–41.

    Article  CAS  PubMed  Google Scholar 

  51. Strasser H, Ninkovic M, Hess M, Bartsch G, Stenzl A. Anatomic and functional studies of the male and female urethral sphincter. World J Urol. 2000;18(5):324–9.

    Article  CAS  PubMed  Google Scholar 

  52. Hollabaugh Jr RS, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology. 1997;49(3):426–34.

    Article  PubMed  Google Scholar 

  53. Srivastava A, Grover S, Sooriakumaran P, Tan G, Takenaka A, Tewari AK. Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy. Curr Opin Urol. 2011;21(1):49–59.

    Article  PubMed  Google Scholar 

  54. Wei JT, Dunn RL, Marcovich R, Montie JE, Sanda MG. Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol. 2000;164(3 Pt 1):744–8.

    Article  CAS  PubMed  Google Scholar 

  55. Burkhard FC, Kessler TM, Fleischmann A, Thalmann GN, Schumacher M, Studer UE. Nerve sparing open radical retropubic prostatectomy—does it have an impact on urinary continence? J Urol. 2006;176(1):189–95.

    Article  PubMed  Google Scholar 

  56. Shafik A. A study of the continence mechanism of the external urethral sphincter with identification of the voluntary urinary inhibition reflex. J Urol. 1999;162(6):1967–71.

    Article  CAS  PubMed  Google Scholar 

  57. Karam I, Droupy S, Abd-Alsamad I, Uhl JF, Benoit G, Delmas V. Innervation of the female human urethral sphincter: 3D reconstruction of immunohistochemical studies in the fetus. Eur Urol. 2005;47(5):627–33. discussion 34.

    Article  PubMed  Google Scholar 

  58. Song LJ, Lu HK, Wang JP, Xu YM. Cadaveric study of nerves supplying the membranous urethra. Neurourol Urodyn. 2010;29(4):592–5.

    CAS  PubMed  Google Scholar 

  59. Alsaid B, Moszkowicz D, Peschaud F, Bessede T, Zaitouna M, Karam I, et al. Autonomic-somatic communications in the human pelvis: computer-assisted anatomic dissection in male and female fetuses. J Anat. 2011;219(5):565–73.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Strasser H, Klima G, Poisel S, Horninger W, Bartsch G. Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate. 1996;28(1):24–31.

    Article  CAS  PubMed  Google Scholar 

  61. Michl UH, Lange D, Graefen M, Huland H. Re: intraoperative nerve stimulation with measurement of urethral sphincter pressure changes during radical retropubic prostatectomy: a feasibility study. C. P. Nelson, J. E. Montie, E. J. McGuire, G. Wedemeyer and J.T. Wei. J Urol, 169: 2225–2228, 2003. J Urol. 2004;171(1):359. author reply.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia

    Wouter Everaerts M.D., Ph.D. & Anthony J. Costello M.D., F.R.A.C.S.

  2. Epworth Healthcare Richmond, 32 Erin Street, Richmond, VIC, 3121, Australia

    Anthony J. Costello M.D., F.R.A.C.S.

Authors
  1. Wouter Everaerts M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony J. Costello M.D., F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wouter Everaerts M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Medical Director of Clinical Research, Co-Director of Urologic Oncology, Section of Urology and Renal Transplantation, Virginia Mason, SEATTLE, Washington, USA

    Christopher R. Porter

  2. Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington, USA

    Erika M. Wolff

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Everaerts, W., Costello, A.J. (2015). Applied Anatomy of the Male Pelvis. In: Porter, C., Wolff, E. (eds) Prostate Ultrasound. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1948-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1948-2_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1947-5

  • Online ISBN: 978-1-4939-1948-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation