Bladder, Bowel, and Sexual Dysfunction After Prostatectomy and Cystoprostatectomy: Anatomical and Physiopathological Considerations

This chapter provides an overview of the key anatomical landmarks of the male pelvis and discusses the changes induced by radical prostatectomy and radical cystectomy. The presentation focuses on the bladder and prostate, sphincters, pelvic floor muscles, and pelvic nervous system, including the pelvic plexus and prostate neuroanatomy. Subsequently, the pathophysiology of postoperative complications following these surgeries is highlighted. Detailed discussion of anatomical changes driven by these two surgeries is provided. Pelvic anatomy is a complex and ever-evolving field, supported by advances in surgical techniques and imaging. Surgeons require a comprehensive understanding of not only the prostatic and vesical anatomy but also the supportive structures surrounding these organs and the neurovascular anatomy. The Retzius-sparing approach has highlighted the importance of anterior support to the urinary sphincter and bladder, resulting in improved urinary continence rates. Preserving sexual function after radical cystectomy is recommended for sexually active men and requires an understanding of the autonomic nervous plexus during extended pelvic lymph node dissection and neurovascular bundle anatomy. It is crucial to consider anatomical and pathophysiological landmarks during radical prostatectomy and radical cystectomy to ensure positive outcomes for patients.