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.
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
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
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
International journal of surgery case reports 2015 Jun 26 [Epub]
William Derval Aiken, Warren Chin
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 , Department of Urology, Kingston Public Hospital, South-East Regional Health Authority, Kingston, WI, Jamaica