Jordan Nasri1,2*, Flora Barthe1,3, Sneha Parekh1 and Ash Tewari1
1Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, USA
2Department of Urology, Claude Huriez Hospital, University of Lille, France
3Department of Urology, Nice University, Pasteur University Hospital, France
Purpose: To review the anatomical facts of prostatic apex discovered over the last years and to discuss the implications for both cancer control and functional recovery after Radical Prostatectomy (RP). Methods: Using the PubMed® database, we searched for peer-reviewed articles in English from January 1985 until today, with the following terms: ‘Prostate apex’, ‘prostatic apex’, ‘anatomy’, ‘radical prostatectomy’, ‘nerve’, ‘continence’ and ‘prostate cancer’. Relevant articles were reviewed, analyzed and summarized. Results: This article gives an insight in the anatomy of the prostatic apex. It rests on different pelvic floor structures (Endo-pelvic fascia, puboperinealis muscle and puboprostatic ligaments), that should be conserved during RP. The shape of prostatic apex varies inter-individually and can influence urethral length preservation. The urethral sphincter might be hampered during apical dissection and dissection of the dorsal vein complex. Prostatic arteries, running laterally to the apex, could be used as landmark for nerve sparring RP. In case of apical accessory pudendal artery, precautions should be taken while performing the vesicourethral anastomosis. In the apical region, the neurovascular bundles are found both posterolaterally and anterolaterally to the urethra, which adds technical difficulties for nerve sparing RP. Conclusion: We provided an overview on the complex anatomy of the prostatic apex and its surrounding structures. Considering this knowledge should help surgeons during RP and result into both better cancer control and improved functional outcomes postoperatively.
Nasri J, Barthe F, Parekh S, Tewari A. Prostatic Apex: Holy Grail of Prostate Cancer Surgery. Clin Surg. 2022; 7: 3482.