title: Is the striated urethral sphincter at risk by standard suture ligation of the dorsal vascular complex in radical prostatectomy? An anatomic study.
abstract: OBJECTIVE
  To perform an anatomic study of the dorsal vascular complex (DVC) and the underlying striated sphincter (SS) to investigate if the SS might be harmed by standard suture ligation in radical prostatectomy.
  
  
  METHODS
  Transverse wholemount serial sections were created from adult male autopsy cadavers. The total surface area of the DVC and the SS were measured at the prostatic apex and 5 mm distal to it using the ImageJ software. The dorsal boundary of the DVC and the ventral border of the SS were defined digitally. The percentage of the surface area of the SS that would be entrapped by a ligation stitch including the entire DVC was then calculated. In addition, 3-dimensional reconstruction of the lower urinary tract was performed using the SURFdriver software.
  
  
  RESULTS
  Five adult male cadavers were investigated. The mean surface area of the SS was 116.1 ± 80.7 and 78.0 ± 63.3 mm(2) at the apex and 5 mm distal to it, respectively. On average, 36.7% (42.6 ± 41.4 mm(2)) and 29.9% (23.3 ± 13.6 mm(2)) of the surface area of the SS were located ventral to the lower boundary of the DVC at the apex and 5 mm distal to it, respectively, and would thus be entrapped by standard suture ligation.
  
  
  CONCLUSIONS
  Our anatomic findings suggest that standard suture ligation of the DVC is associated with the risk of affecting sphincter tissue. Our study is in accordance with recent clinical studies showing improved early postoperative continence rates by primary transection of the DVC followed by selective suture ligation.
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany. Electronic address: roman.ganzer@medizin.uni-leipzig.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Ganzer
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Neuhaus
authors.affiliation: Department of Pathology, University of Regensburg, Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Weber
authors.affiliation: Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bründl
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001707:Biopsy, Needle; D002102:Cadaver; D006801:Humans; D021621:Imaging, Three-Dimensional; D007150:Immunohistochemistry; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000033:anatomy & histology / Q000098:blood supply* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery*