Analysis of the Current Surgical Anatomical Knowledge of Radical Prostatectomy: An Updated Review

Abstract

Background and objective: New anatomical studies have emerged since the last prostatic surgical anatomy review published in 2016. Our goal is to present the latest periprostatic anatomical understanding.

Methods: PubMed was queried to identify articles covering prostate anatomy, emphasizing work published from 2016 to 2025.

Key findings and limitations: The endopelvic fascia partially engulfs the prostate laterally. Meanwhile, the prostatic fascia surrounds the medial aspect. The anterior fibromuscular stroma reinforces the prostatic stroma ventrally. The detrusor apron is continuous with anterior bladder muscle fibers, which anchors to the posterior pubis. Posterolaterally, the prostate is adjacent to a predominant neurovascular bundle. The external and internal sphincters, along with membranous urethra, are components of the urethral sphincter complex. At the prostatic base, the seminal vesicles are anteromedial to the adjoining proximal neurovascular plate. Autonomic and somatic fibers innervate the prostate, from T11-L2 and S2-S4 rami. In a spray-like pattern, autonomic fibers are distributed into the neurovascular bundle, the proximal plate, and accessory pathways. Synthesizing the most recent surgical anatomy research, we also created a three-dimensional animation.

Conclusions and clinical implications: The prostate is a dense organ with muscular and glandular features. Located within the true pelvis, the prostate is surrounded by several fascial planes that contain the neurovascular structures. Lumbosacral parasympathetic nerve root fibers of the pelvic plexus run posterolateral to the prostate gland in a neural hammock configuration. This anatomic understanding informs the nerve-sparing technique. Finally, the anterior ligamentous structures play a role in continence and possibly erectile function too.

Keywords: Anatomy; Fascia; Prostate cancer; Prostatectomy; Sacral plexus.