Pelvic organ prolapse and/or hypermobility of the bladder may indicate a weakening of the endopelvic
fascia and may cause sexual pain.
Our RARP dissection begins with a limited posterior dissection to identify the seminal vesicles and vasa deferentia, followed sequentially by release of the bladder and development of the retropubic space, bilateral extended pelvic lymphadenectomy, resection of preprostatic fat and nodal tissue, endopelvic
fascial incision, bladder neck dissection, an antegrade approach to pedicle division and nerve-sparing, ligation and division of the dorsal venous complex, division of the prostatic apex and urethra, specimen removal, and vesicourethral anastomosis.
fascia was opened and completely separated from the prostate levator muscle and made spherical.
It is also claimed to cause endopelvic
fascia and connective tissue injuries due to forcing or stretching during delivery.
2%, respectively, in their 2,625 patients in whom lateral prostatic fascia and endopelvic
fascia were preserved during RALP.
After excising the fistulous tract, the first layer sutured is the bladder mucosa, followed by the detrusor and/or prevesical or endopelvic
fascia, and the third or fourth layer incorporates vaginal epithelium.
Upon entry into the space of Retzius, the endopelvic
fascia was not incised to maximize nerve-sparing technique as part of Samadi Modified Advanced Robotic Technique (SMART) .
Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic
fascia defect repair for treatment of pelvic organ prolapse.
After the endopelvic
fascia had been opened, the division of the puboprostatic ligaments was avoided.
DISCUSSION: Uterine prolapse occurs most commonly in multiparous and post-menopausal women because of injury to the endopelvic
fascia and levator ani muscles.
A woman who has scarred, deficient endopelvic
fascia has a greater chance of a recurrence and is therefore a good candidate for a mesh procedure.
This occurs due to a disruption in the endopelvic
fascia and the levator ani muscles, resulting in loss of support of the bladder neck and proximal urethra (Yoshimura et al.