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N15 Surgical anatomy of the prostatic urethra. A pilot ex vivo study

      Introduction and Objectives

      According to literature the majority of urologist become familiar with prostate anatomy. However, the perception of the prostatic urethra (PU) anatomy is based on personal endoscopic experience. PU seems to be integrated, non removable part of the prostate. Nevertheless, a robotic laparoscopy has potential for performing microsurgical movements and the idea to perform urethra-sparing operations of prostate could be taken into consideration. Before we formulate the concept of clinical use, the pilot study on surgical anatomy of prostatic urethra has been done. The aim of the pilot study was to discover and evaluate surgical anatomy of PU by performing ex vivo post-prostatectomy preparation.

      Material and Methods

      50 specimens of prostate and PU collected from 32 radical prostatectomies (RP) and 18 radical cystectomies (RC) were analyzed postoperatively ex vivo. An individual programme of the anatomical preparation of PU was engaged in all cases prior to the pathological examination. A three-stage procedure was performed: 1) a preparation of prostate gland and PU excision, 2) a pre-pathological specimen preparation with photo documentation, 3) final pathological report. Immediately after the surgery, each specimen was placed on the posterior surface and fixed with the basis upward. Then, it was prepared gently with the incision dissecting the anterior surface of the gland leading towards PU. In order to minimalize the risk of PU disruption, a catheter was inserted intraurethrally. Along with the dissection, the prostate was flattened gradually and the urethra was separated intact from its site, being only attached by ejaculatory duct. In overall, two specimens: prostate and PU were prepared. Next, the standard pre-pathological preservation was performed along with the special tools immobilizing specimens that flattened the prostate. Subsequently, both prostate and PU were analyzed microscopically.

      Results

      The time of ex vivo preparation of a single specimen varied from 10 to 21 min. (mean 12 min.). In all cases, PU was excised intact. Mean lenght of PU was 19mm (9-27 mm). PU was involved by the cancer in none of the cases (0%). The number of ejaculatory ducts was found to be as follows: one − 80% of cases, two − 14%, three − 4%, four − 2%. Pathologies of PU site were not found. Each step of the study procedure was documented digitally and will be presented on the poster. The findings of final pathological examinations were as follows: RP – adenocarcinoma pT1c–18 cases (56%), pT2a–9, pT2b–4, pT3a–1; RC – TCC pT0–1 case, pT1–1, pT2–12, pT3–3, pT4–1.

      Conclusions

      The study and photo documentation may improve our knowledge on the anatomy of PU and revealed feasibility of PU excision being attached. The fact that PU is cancer negative enables the idea to do urethra sparing surgery theoretically promising. The individual protocol occurred to be an interesting alternative for the standard oncological assessment of prostate specimens.