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No AccessJournal of UrologyAdult urology1 Feb 2007

The Anterior Layer of Denonvilliers’ Fascia: A Common Misconception in the Laparoscopic Prostatectomy Literature

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    Purpose:

    Incision of the anterior layer of Denonvilliers’ fascia is commonly cited as a key step in successful dissection of the vasa deferentia and seminal vesicles from the posterior bladder neck during laparoscopic radical prostatectomy. However, anatomical descriptions do not support the presence of Denonvilliers’ fascia anterior to the seminal vesicles. To address this inconsistency we performed a detailed anatomical study of tissue planes encountered during laparoscopic dissection of the posterior bladder neck.

    Materials and Methods:

    To grossly characterize the tissue planes encountered during laparoscopic posterior bladder neck dissection, ex vivo dissections were performed on 4 separate cystoprostatectomy specimens. Biopsies of the representative areas were obtained from 20 consecutive laparoscopic radical prostatectomy specimens by 2 dedicated uropathologists.

    Results:

    Following incision into the posterior bladder neck mucosa, longitudinally oriented fibers were readily visualized, extending from bladder neck to prostate base. Histologically this anatomical landmark represents the fusion of 2 separate tissue layers, that is an inner lamella composed of longitudinally disposed smooth muscle fibers in continuation with the longitudinal fascia of the bladder detrusor (medial fascicle of the detrusor running in between the ureters) and an outer lamella composed of fibroadipose tissue in continuation with the bladder adventitia.

    Conclusions:

    Our anatomical and histological analysis refutes the prevailing belief in the laparoscopic literature that the longitudinal muscle fibers identified during dissection of the posterior bladder neck represent the anterior layer of Denonvilliers’ fascia. They correspond to the posterior longitudinal fascia of the detrusor muscle that is externally upholstered by the bladder adventitia.

    References

    • 1 : Laparoscopic radical prostatectomy: the Montsouris technique. J Urol2000; 163: 1643. LinkGoogle Scholar
    • 2 : Denonvilliers’ fascia lies anterior to the fascia propria and rectal dissection plane in total mesorectal excision. Dis Colon Rectum2005; 48: 37. Google Scholar
    • 3 : The anatomy and embryological origins of the fascia of Denonvilliers’s: a medico-historical debate. J Urol1997; 157: 3. LinkGoogle Scholar
    • 4 : Endoscopic extraperitoneal radical prostatectomy: initial experience after 70 procedures. J Urol2003; 169: 2066. LinkGoogle Scholar
    • 5 : Laparoscopic radical prostatectomy: review and assessment of an emerging technique. Surg Endosc2004; 18: 1694. Google Scholar
    • 6 : Nerve sparing laparoscopic radical prostatectomy: our technique. Eur Urol2006; 49: 344. Google Scholar
    • 7 : Transperitoneal laparoscopic radical prostatectomy: ascending technique. J Endourol2004; 18: 593. Google Scholar
    • 8 : Extraperitoneal laparoscopic radical prostatectomy: a prospective evaluation of 600 cases. J Urol2005; 174: 908. LinkGoogle Scholar
    • 9 : The window sign: an aid in laparoscopic and robotic radical prostatectomy. Int Urol Nephrol2005; 37: 73. Google Scholar
    • 10 : Laparoscopic radical prostatectomy—results of 200 consecutive cases in a Canadian medical institution. Can J Urol2004; 11: 2172. Google Scholar
    • 11 : Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system. J Urol2003; 170: 416. LinkGoogle Scholar
    • 12 : An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol2003; 43: 444. Google Scholar
    • 13 : Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am2004; 31: 701. Google Scholar
    • 14 : A quest for better nerve preservation in Vattikuti Institute prostatectomy (VIP): the veil of Aphrodite. : 2005. Presented at annual meeting of American Urological Association, San Antonio, Texas, May 21–28. Google Scholar
    • 15 : Morphology and Function of Vesico-Prostato-Urethral Musculature. Treviso: Edizioni di Urologia1968: 334. Google Scholar
    • 16 : A new theory of micturition and urinary continence based on histomorphological studies. 2. The musculus sphincter vesicae: continence or sexual function?. Urol Int1994; 52: 154. Crossref, MedlineGoogle Scholar
    • 17 : Propositions et observation d’anatomie, de physiologie at de pathologie. These de l’Ecole de Medicine1837; 285: 23. Google Scholar
    • 18 : Anatomical and surgical restudy of Denonvilliers’s fascia. Surg Gynecol Obstet1945; 80: 373. Google Scholar
    • 19 : The development and surgical importance of the rectourethralis muscle and Denonvilliers’ fascia. J Urol1922; 8: 339. LinkGoogle Scholar
    • 20 : The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol1993; 36: 976. Google Scholar
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