By Jay Y. Gillenwater MD, John T. Grayhack MD, Stuart S. Howards MD, Michael E. Mitchell MD
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Additional info for Adult and Pediatric Urology (3-Volume Set)
79. A: Several thin branches emerging from the pudendal nerve course to caudal third of urethra entering the rhabdosphincter at the lateral aspects. B: Corresponding drawing to A. Radical Prostatectomy Retropubic Versus Perineal Approach The perineal approach, by preserving the paraprostatic tissue (lateral pelvic fascia), avoids injury to the dorsal vein complex. In a perineal prostatectomy, the prostate is removed within the paraprostatic tissue, whereas the retropubic prostatectomy removes the prostate together with all paraprostatic tissue.
72. Anatomic specimen (adult rhabdosphincter, cranial view). RS, rhabdosphincter; U, urethra. Histology. The histologic findings in adult men confirm the data gained by gross anatomic examination (Fig. 73). The rhabdosphincter is a vertical muscular coat ventral and lateral to the prostate and membranous urethra extending from the bulb of the penis toward the region of the bladder neck. In all investigated specimens, striated muscle fibers corresponding to the deep transverse perineal muscle cannot be identified.
22). 22. Incision of the lumbodorsal fascia. 18 As the twelfth rib is displaced downward and forward with a retractor, the lumbodorsal fascia is dissected from the inner periosteum of the rib (Fig. 23). This affords extrapleural entry to the thoracic cavity while sparing the intercostal nerves and vessels. The route of this approach is shown schematically in Fig. 24 . 23. The thoracic cavity is opened extrapleurally, preserving the intercostal vessels and nerves. 24. Schematic view of the dissection of the lumbodorsal fascia from the deep periosteum of the rib.