It is humbling to realize that even today basic anatomy may not be known or understood.

Walsh's quotation relative to radical prostatectomy admonishes other surgeons who perform this surgery and take lightly the knowledge of anatomy. The goals of radical prostatectomy have been crystallized as (1) cure of disease, (2) urinary control, and (3) preservation of erectile function.<sup>55 Walsh P.C. Anatomic radical retropubic prostatec-tomy—an update after 2000 cases. Campbell's Urology Updates: Update 21 Philadelphia: WB Saunders (1997).  1

Cliquez ici pour aller à la section Références</sup> Unfortunately, these key ingredients for health and quality of life postoperatively will remain elusive for significant numbers of patients until understanding of the complex anatomy of the pelvic floor is more widespread. As a nineteenth century plaque on the wall in the Anatomy Museum in Basel, Switzerland, warns (translating the German), “Surgeons who ignore anatomy are like moles. They work in the dark and pile up dirt!”

At the heart of the complexity of the male pelvis is significant individual variation. Some pelves are wide, making the prostate readily accessible, whereas other pelves are deep and narrow, making access to the prostate a test of patience, especially in the presence of morbid obesity. Because the width of the pelvic arch varies,<sup>34 Myers R.P., Cahill D.R., Devine R.M. , et al. Anatomy of radical prostatectomy as defined by magnetic resonance imaging J Urol 1998 ;  159 : 2148  [cross-ref]

Cliquez ici pour aller à la section Références</sup> prostate size must be assessed before radical perineal prostatectomy, the perineal operation. Variation also applies to prostate architecture in terms of size and shape, which are affected by the presence or absence of benign prostatic hyperplasia (BPH). Beyond the prostate, the surgeon must understand the pelvic fascia and pelvic floor musculature, including the levator ani and associated musculature, which includes the anal sphincters and the bulbospongiosus. Disposition of the rectum, anal canal, and anorectal flexure relative to the prostate apex is key to successful radical retropubic prostatectomy (the retropubic operation) and the perineal operation. Relationships of the prostate to the bladder, urethra, penis, and pubis are also germane. The neurovascular structures must be defined clearly in the surgeon's mind before operating. Variation is a part of every anatomic aspect of the pelvis. Textbooks often present only one configuration among many. Errors in illustration abound and are perpetuated by copying without substantiating validity.

The anatomic illustrations in this article are drawn from fresh gross specimens taken at autopsy, from radical prostatectomy specimens, from MR images, and from histologic material, as in previous related publications on surgical anatomy of the prostate.<sup>28 Myers R.P. Male urethral sphincteric anatomy and radical prostatectomy Urol Clin North Am 1991 ;  18 : 211

Cliquez ici pour aller à la section Références, 29 Myers R.P. Practical pelvic anatomy pertinent to radical retropubic prostatectomy AUA Update Series 1994 ;  13 (lesson 4) : 26

Cliquez ici pour aller à la section Références, 30 Myers R.P. Radical prostatectomy: Pertinent surgical anatomy Atlas Urol Clin North Am 1994 ;  22 : 1  [cross-ref]

Cliquez ici pour aller à la section Références, 31 Myers R.P. An anatomic approach to the pelvis in the male Current Genitourinary Cancer Surgery Baltimore: Williams & Wilkins (1997).  155

Cliquez ici pour aller à la section Références, 32 Myers R.P. Anatomy and physiology of the external urethral sphincter: Implications for preservation of continence after radical prostatectomy. Recent Advances in Prostate Cancer and BPH New York: Parthenon Publishing (1997).  81

Cliquez ici pour aller à la section Références, 33 Myers R.P. Anatomy of the prostate: Surgical implications. Principles and Practice of Genitourinary Oncology Philadelphia: Lippincott-Raven (1997).  357

Cliquez ici pour aller à la section Références, 36 Myers R.P., Goellner J.R., Cahill D.R. Prostate shape, external striated urethral sphincter and radical prostatectomy: The apical dissection J Urol 1987 ;  138 : 543

Cliquez ici pour aller à la section Références</sup> Because the illustrations herein are based on drawings of real material or photographs of actual specimens, the reader should be able to make a practical translation from textbook to patient and avoid unnecessary surgical error based on mistaken notions of how things ought to be.