전립선 및 전립선 주위 조직의 해부학적 구조 분석: 근치적 후치골 전립선적출술 시 고려 사항
Anatomical Analysis of Prostate and Surrounding Struc- tures: Points to Consider during Radical Retropubic Prostatectomy
이상은, 변석수, 홍성규, 이학종, 김용준, 장인호, 길명철,
소속 상세정보
이상은 ( Lee Sang-Eun )
서울대학교 의과대학 비뇨기과학교실
변석수 ( Byun Seok-Soo )
서울대학교 의과대학 비뇨기과학교실
홍성규 ( Hong Sung-Kyu )
서울대학교 의과대학 비뇨기과학교실
이학종 ( Lee Hak-Jong )
서울대학교 의과대학 방사선과학교실
김용준 ( Kim Yong-June )
서울대학교 의과대학 비뇨기과학교실
장인호 ( Chang In-Ho )
서울대학교 의과대학 비뇨기과학교실
길명철 ( Gil Myung-Cheol )
서울대학교 의과대학 비뇨기과학교실
KMID : 0358320060470060568
Abstract
Purpose: To investigate the prevalences of anatomical variations regarding prostate and its surrounding structures, and also the intra- and postoperative effects of such anatomical variations in performing radical retropubic prostatectomy(RRP). Materials and
Methods: A retrospective analysis of 156 patients who received RRP for prostate cancer was performed. Patients’ records including the results preoperative radiologic evaluations were reviewed. For our analysis, patients were grouped according to the anatomical variations relevant to prostate and surrounding structures shown on preoperative radiographs. Also, patients were interviewed via telephone as needed.
Results: Prostate volume(mean: 41.4ml) measured from preoperative transrectal ultrasound correlated with estimated blood loss(EBL) during RRP(p=0.029). Interspinous diameter(mean: 1.69cm) measured on axial image of preoperative magnetic resonance imaging(MRI) was observed to be inversely correlated with operative time(p=0.010). And, patients with box-shaped deep dorsal vein(as demonstrated on axial view of MRI; 15.3%) were observed to have significantly less EBL during RRP(p=0.030). Also, EBL was significantly higher(p=0.013) for patients in which anterior portion of prostatic apex appeared to overlap and obscure membranous urethra(62.8%). Meanwhile, absence of the distal protrusion of apical region (21.8%) was observed to be associated with early(within 3 postoperative months) recovery of urinary continence(p=0.014).
Conclusions: Our results suggest that various anatomical variations regarding prostate and its surrounding structure may exist as herein presented, and also that they may indeed have significant effects on both intra- and postoperative course regarding RRPs. Variations in the shape of prostatic apex may be significantly associated with recovery of continence after RRPs. (Korean J Urol 2006;47:568-577)
키워드
Prostatic neoplasms; Prostatectomy; retropubic; Anatomy
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