Surgical approaches to the prostate gland
The anatomical approach to the organ depends on the nature of the pathology and the chosen treatment method. There are four main surgical routes:
- Transvesical (Transvesical) — surgical intervention performed through an incision of the anterior abdominal wall and the anterior wall of the urinary bladder.
- Perineal (Perineal) — a route through the soft tissues of the perineum located in the space between the root of the scrotum and the anus.
- Transurethral (Transurethral) — an endoscopic method performed through the lumen of the urethra without forming external incisions on the body.
- Retropubic (Retropubic) — an extraperitoneal approach passing behind the pubic symphysis (symphysis pubis) without incising the bladder wall.
Stages of transvesical adenomectomy
Open surgery to remove benign hyperplasia (adenoma) involves exposing the organ and directly dissecting the pathologically altered tissue.
- The surgeon makes an incision in the capsule of the prostate gland.
- Mechanical peeling of the hyperplastic adenoma tissue is performed directly from the surgical capsule of the organ.
- The enucleation process is monitored palpatorily to prevent damage to surrounding structures.
Use of bimanual technique
For effective removal of adenomatous nodes during a transvesical intervention, the surgeon uses both hands simultaneously:
- The right hand is inserted through the incision into the cavity of the urinary bladder. Its index finger performs the main task — direct enucleation of the adenomatous nodes.
- The left hand is used rectally: the index finger is placed into the rectum (per rectum). It pulls the prostate gland upward toward the urinary bladder and securely fixes it, creating support for the finger working inside the bladder.
Specifics of interventions for inflammation and tumors
The choice of surgical tactics is directly dictated by the clinical presentation of the disease:
- In purulent processes (such as abscessing prostatitis and various abscesses), opening of the capsule is indicated. For this, a perineal or transrectal approach is used.
- In tumors, the main treatment method is adenomectomy, which is performed via a suprapubic or perineal approach.
Briefly: answers to topical questions
What anatomical layers are incised during the transvesical approach to the prostate gland?
During the transvesical approach to the prostate gland, access is gained through an incision of the anterior abdominal wall and the anterior wall of the urinary bladder. For high suprapubic cystostomy, sources indicate the use of the prevesical cellular space (spatium prevesicale), which is bounded anteriorly by the transversalis fascia and posteriorly by the prevesical fascia.
Which venous plexuses may bleed during adenomectomy?
In the area of the prostate gland and the prevesical space, sources indicate the following venous plexuses:
- Prostatic venous plexus (plexus prostaticus).
- Vesical venous plexus (plexus vesicalis).
The veins of the prostate gland form the plexus prostaticus, which merges with the plexus vesicalis and drains into the internal iliac vein (v. iliaca interna).
Which neural structures can be damaged during prostate surgeries?
The provided sources do not specify which neural structures can be damaged during prostate surgeries. Only the innervation of the male genitalia is indicated:
- Hypogastric plexus: sympathetic fibers go to the seminal vesicles, prostate gland, and vas deferens; stimulation of the hypogastric plexus causes ejaculation.
- Pelvic splanchnic nerves: parasympathetic fibers from segments S2–S4 go to the corpora cavernosa; activation causes erection.
- Pudendal nerve: innervates the urethral sphincter, ischiocavernosus, and bulbospongiosus muscles.
Four "P"s of surgical approaches: Posterior (retropubic), Perineal, as well as Pelvic (transvesical) and Passage endoscopic (transurethral).
Class and exam questions
What are the main approaches used in prostate surgery?
Four main approaches are distinguished: transvesical, perineal, transurethral (endoscopic), and retropubic extraperitoneal.
What is the essence of the bimanual technique in transvesical adenomectomy?
The surgeon's right hand is in the bladder cavity and enucleates the adenoma, while the index finger of the left hand is inserted into the rectum (per rectum) to push the gland upward and fix it.
How is surgery performed for purulent diseases of the prostate gland?
In abscessing prostatitis and abscesses, the capsule of the organ is opened using a perineal or transrectal approach.
What else to study on this topic
- Anatomical structure of the prostate gland and its surgical capsule
- Comparative characteristics of transurethral and open methods
- Technique of retropubic approach without opening the urinary bladder
- Indications and contraindications for the perineal approach
- Prevention of complications during the enucleation of adenomatous nodes
Master the complete topic in the "Topographic Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Full study guide on "Prostate Adenomectomy" and 2,777 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 91 video lessons on the subject
Other topics in the section «Pelvic and Perineal Surgery»
Free video lessons: topographic anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.