title: Surgical access for radical retropubic prostatectomy in the phenotypically narrow and steep black male's pelvis is exacerbated by a posterior pubic symphyseal protuberance: A case report.
abstract: BACKGROUND
  Men of African descent are known to have a narrower and steeper pelvis that is associated with a higher risk of positive surgical margins after radical retropubic prostatectomy. We describe the additional challenge posed when a very prominent posterior pubic symphyseal protuberance is present in the pelvis of a Black man during this operation and how to overcome it.
  
  
  METHODS
  A 61-year old man of African-descent with organ-confined prostate cancer underwent a radical retropubic prostatectomy. He had a very prominent posterior pubic symphyseal protuberance on a background of a phenotypically narrow and steep pelvis, precluding adequate surgical access to the prostate. Using a combination of resection of the protuberance, modification of patient position and lighting, coordinated retraction and long instruments, surgical access was achieved.
  
  
  CONCLUSIONS
  The coexistence of a very prominent posterior pubic symphyseal protuberance in a Black male with a narrow and steep pelvis poses a surgical challenge in accessing the prostate, particularly the apex. This can be overcome by surgical resection of the protuberance, patient waist extension by operating table flexion, use of head lamps or intracavitary lighting, adequate retraction and use of appropriately long instruments.
  
  
  CONCLUSIONS
  Surgical access to the prostate, particularly its apex, when performing radical retropubic prostatectomy in a Black man with a very prominent posterior pubic symphyseal protuberance may be achieved by a combination of manoeuvres and adjuncts described herein.
authors.affiliation: Division of Urology, Section of Surgery, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, WI, Jamaica. Electronic address: william.aiken@uwimona.edu.jm.
authors.forename: William Derval
authors.initials: WD
authors.lastname: Aiken
authors.affiliation: Department of Urology, Kingston Public Hospital, South-East Regional Health Authority, Kingston, WI, Jamaica. Electronic address: chin.urology@gmail.com.
authors.forename: Warren
authors.initials: W
authors.lastname: Chin
keywords: Black men; Male pelvis; Prostate cancer; Protuberance; Pubic symphysis; Radical retropubic prostatectomy