Oktay AKÇA, Savaş YALÇIN, Rahim HORUZ, Mustafa BOZ, Ahmet SELİMOĞLU, Alper KAFKASLI, Cihangir ÇETİNEL, Çağlar ÇAKIR, Selami ALBAYRAK

Radikal retropubik prostatektomi: Prostat ile birlikte hangi dokular çıkıyor?

Giriş: Radikal retropubik prostatektomi RRP spesmeni üzerinde bulunan dokuları histolojik açıdan değerlendirmek.Gereç ve Yöntemler: Kliniğimizde tek cerrahın serisi olarak 30 RRP yapıldı. Patolojik spesmenler apeksten tabana doğru dilimlendi. Bir adet apeksten, iki adet orta prostattan ve 1 adet tabandan olmak üzere 4 adet dilim seçildi. Dilimler transvers planda üretra ortada kalacak şekilde 4 kadrana ayrıldı. Kadranlar, yüzeyel kısımlarında bulunan ve prostatın güncel anatomik ve histolojik bilgileri ışığında belirlenmiş 7 parametre; “Dorsal venöz kompleks DVC ”, “Çizgili kas Rabdosfinkter ”, “Periprostatik fasiyal doku PPFD ”, “Damar sinir paketi”, “Mesane boynu düz kas lifleri”, “Cerrahi sınır” ve “Kapsüler insizyon” yönüyle histolojik olarak araştırıldı.Bulgular: Apekste DVC tüm spesmenlerde gözlenirken çizgili kas 28 %93,3 hastada ve özellikle prostatın ön yüzünde gözlendi. PPFD prostatın arka yüzünde ağırlıklı olmak üzere spesmenlerin hepsinde gözlendi. Damar sinir paketi 23 %76,6 hastada gözlenmekle birlikte prostatın posterior yüzünde daha fazlaydı. Prostatın taban kesitlerinde spesmenlerin tümünde düz kas yapıları vardı. Cerrahi sınır pozitifliği 9 %30 hastada gözlenmekle birlikte bunların 7 tanesi apekste idi. Kapsüler insizyon 9 %30 hastada pozitifti.Sonuç: Bu çalışmada RRP ameliyatı sonucunda elde edilen prostatektomi materyalinin üzerinde hangi dokuların bulunduğu kantitatif olarak gösterilmiş oldu. Bu bulguların hem prostat anatomisi hem de prostatın cerrahisi açısından yeni fikirler doğurabileceğini düşünmekteyiz

Anahtar Kelimeler:

Prostatektomi, Spesmen, Histoloji

Radical retropubic prostatectomy: Which tissues come with prostate?

Objective: Histological evaluation of tissues found on specimens of radical retropubic prostatectomy RRP .Material and Methods: A single surgeon’s series of 30 RRP specimens were evaluated. The RRP specimens were dissected from apex to basis. The following slices were dissected: 1 from the Apex, 2 from the center of the prostate, and 1 from the basis. Tissue surrounding these slices were histologically evaluated working from the following 7 parameters determined in light of latest anatomical and pathological insight on the prostate: “Dorsal venous complex DVC ”, “Striated muscle Rhabdosphincter ”, “Periprostatic fascial tissue PPFT ”, “Neurovascular bundle NVB ”, “Bladder neck smooth muscle”, “Surgical margins” and “Capsular incision”.Results: Whilst DVC was found whole in the dissected apex slices, muscle striation was found with 28 93.3% of the patients. PPFT within central prostate sections was found with all of the patients, predominantly within posterior quadrants. Again within central prostate sections NVB was found with 23 76.6% of the patients, predominantly within posterior quadrants. All basis slices were found to have bladder neck smooth muscle. Surgical margin positivity was found with 9 30% of the patients, 7 of them were in the apex. Capsular incision was found with 9 30% of the patients.Conclusion: A quantitative report of the extent to which other anatomical structures are extracted when removing the prostate employing the RRP technique, were provided with this study. We think that, these findings might provide new ideas about prostate anatomy as well as radical prostatectomy surgery techniques

Keywords:

Prostatectomy, Specimen, Histology,

PDF

___

Greenlee RT, Hill-Harmon MB, Murray T, et al. Cancer sta- tistics. CA Cancer J Clin 2001;51:15–36.
Reiter RE, deKernion JB. Carcinoma of the prostate. In: Walsh PC, Retik AB, Vaughan ED, eds. Campbells Urology. 8th ed. New York, Saunders, 2002;3003-3024.
Catalona WJ. Surgical management of prostate cancer: Contemporary results with anatomic radical prostatectomy. Cancer 1995;75:1903-1908.
Asimakopoulos AD, Annino F, D’Orazio A, et al. Comple- te periprostatic anatomy preservation during robot-assisted laparoscopic radical prostatectomy (RALP): the new pubo- vesical complex-sparing technique.Eur Urol 2010;58:407- 417.
Takenaka A, Tewari AK, Leung RA, et al. Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatec- tomy: anatomic basis and preliminary outcomes. Eur Urol 2007;51:433-440.
Ou YC, Yang CK, Wang J,et al. The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D’Amico risk criteria. Eur J Surg Oncol 2013;39:107-113.
Jochen Walz, Arthur L. Burnett, Anthony J. Costello, et al. A Critical Analysis of the Current Knowledge of Surgical Ana- tomy Related to Optimization of Cancer Control and Pre- servation of Continence and Erection in Candidates for Ra- dical Prostatectomy. Eur Urol 2010;57:179-192.
Gianduzzo TR., Jose R. Colombo, Ehab El-Gabry et al. Ana- tomical and Electrophysiological Assessment of the Cani- ne Periprostatic Neurovascular Anatomy: Perspectives as a Nerve Sparing Radical Prostatectomy Model. J Urol 2008;179:2025-2029.
Christian Eichelberg, Andreas Erbersdobler, Uwe Michl, et al. Nerve Distribution along the Prostatic Capsule. Eur Urol 2007;51:105-110.
Van der Poel HG and de Blok W. Role of extent of fascia pre- servation and erectile function after robot-assisted laparos- copic prostatectomy. Urology 2009;73:816-821.
Van der Poel HG, de Blok W, Joshi N, van Muilekom E. Pre- servation of Lateral Prostatic Fascia is Associated with Uri- ne Continence after Robotic-Assisted Prostatectomy. Eur Urol 2009;55:892-900.
Shikanov S, Woo J, Al-Ahmadie H et al. Extrafascial Versus Interfascial Nerve-sparing Technique for Robotic-assisted Laparoscopic Prostatectomy: Comparison of Functional Outcomes and Positive Surgical Margins Characteristics. Urology 2009;74:611–616.
Zorn KC, Gofrit ON, Orvieto MA et al. Robotic-Assisted Laparoscopic Prostatectomy: Functional and Pathologic Outcomes with Interfascial Nerve Preservation. Eur Urol 2007;51:755–62.