STOCKHOLM, SWEDEN (UroToday.com) - To investigate whether standard suture ligation of the dorsal vein complex (DVC) can harm the striated urethral sphincter (SS), Dr. R. Ganzer presented an anatomical study of 5 adult male autopsy cadavers. Following a standardized autopsy protocol they removed the urogenital organs en bloc, and then serially-transversed, whole-mount sections were created with an interval of 1 mm, and then stained with hematoxyline-eosin (HE). From all specimens, one section was investigated from the level of the prostatic apex and one 5 mm distal to the apex. They used ImageJ software (Wayne Rasband, National Institute of Health, USA) to measure the number and total surface area of the veins of the DVC and of the SS. The percentage of surface area of the SS that could be entrapped by a ligation DVC stitch was calculated. They reported a mean of 12.5 ± 3.8 and 12.0 ± 3.5 veins at the level of the apex and 5 mm distal to the apex, respectively. For total surface area of the SS, they reported a mean of 13.3 ± 4.6 mm2 and 11.7 ± 6.9 mm2 at the level of the apex and 5 mm distal to the apex, respectively. The mean surface area of the SS was 116.1 ± 80.7 mm2 and 80.9 ± 63.6 mm2, respectively. In regards to surface area of the SS above the lower border of the DVC, the mean was 42.5 ± 41.4 mm2 (36.6%, range 16.4%-55.4%) and 28.4 ± 20.7 mm2 (35.1%, range 22.6%-62.7%) at the apex and 5 mm distal to the apex, respectively.
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Findings from this study suggest that a standard suture ligation technique of the DVC is associated with a high risk of affecting sphincter tissue. A considerable percentage of the surface area of the SS is located above the lower level of the DVC at the apex and 5 mm distal to the apex and they are typical locations for ligating the DVC during radical prostatectomy. Even though this study is in accordance with other studies showing improved early postoperative continence rates by transection of the DVC followed by selective suture ligation, others have shown good continence results with the “ligate & cut” technique. These sorts of studies suggest that despite the surgical technique and technology, the “trifecta” result of prostatectomy highly depends on the experience and volume of the surgeon.
Presented by R. Ganzer at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
University of Leipzig, Dept. of Urology, Leipzig, Germany
Written by Reza Mehrazin, MD, medical writer for UroToday.com