Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

Abstract

PURPOSE:To evaluate the structure of the endopelvic fascia in prostates of different weights. METHODS:We studied 10 patients with BPH (prostates>90g); 10 patients with prostate adenocarcinoma (PAC) (prostates<60g) and five young male cadavers (control group). During the surgery a small sample of endopelvic fascia was obtained. We analyzed elastic fibers, collagen and smooth muscle. The stereological analysis was done with the Image Pro and Image J programs. Means were statistically compared using the one-way ANOVA with the Bonferroni test and a p<0.05 was considered statistically significant. RESULTS:The mean of the prostate weight was 122 g in BPH patients, 53.1g in PAC patients and 18.6g in control group. Quantitative analysis documented that there are no differences (p=0.19) in Vv of elastic fibers and in Vv of type III collagen (p=0.88) between the three groups. There was a significant difference (p=0<0.0001) in the quantification of SMC in patients with prostates >90g (mean=9.61%) when compared to patients with prostates <60g (mean=17.92%) and with the control group (mean=33.35%).CONCLUSION: There are differences in endopelvic fascia structure in prostates>90g, which can be an additional factor for preoperatory evaluation of radical prostatectomy.

The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1

“…The transversalis fascia covers the viscera of the pelvic space transforming into an endopelvic fascia; the latter is divided into parietal and visceral fascia [7]. The endopelvic fascia covers the muscles that form the pelvic floor (levator ani and the ischiococcygeus muscle), the internal obturator and the piriformis muscle; finally, it merges with the presacral and periosteal fascia of the pubic area [42]. In the path of the endopelvic fascia, we find other small portions of connective tissue such as the Denonvilliers fascia (between the rectum and the seminal vesicles in men or between the rectum and vagina in women or the rectogenital fascia), the Walderyer fascia (between the posterior portion of the rectum at the caudal level of the sacrum and the presacral fascia or rectosacral fascia) [43].…”