ABSTRACT Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.

Resumo A angiografia convencional ainda é considerada o exame padrão ouro no estudo da anatomia e das doenças vasculares do abdome. Entretanto, com o advento da tomografia computadorizada com multidetectores e técnicas de reconstrução de imagens digitais, este exame tem-se tornado uma opção, com a vantagem de não ter os riscos habituais dos exames angiográficos invasivos. Com isso, o aprofundamento do conhecimento dos detalhes anatômicos da vasculatura regional e suas variações é cada vez mais exigido nesta área da radiologia. As variações do sistema vascular renal são relativamente prevalentes, tanto no leito venoso quanto no arterial. O conhecimento do tema é de importância nas várias condições em que o prévio planejamento cirúrgico é crucial para o sucesso do procedimento. Para familiarizar o radiologista geral, enriquecendo sua experiência sobre o tópico, os autores elaboraram um ensaio iconográfico a partir de uma série de casos extraídos do banco de imagens de tomografia computadorizada com multidetectores da região abdominal, com os padrões representativos das mais frequentes variações anatômicas da irrigação arterial renal, chamando a atenção para sua designação terminológica e para suas implicações clinicocirúrgicas.

Abstract Conventional angiography is still considered the gold standard for the study of the anatomy and of vascular diseases of the abdomen. However, the advent of multidetector computed tomography and techniques of digital image reconstruction has provided an alternative means of performing angiography, without the risks inherent to invasive angiographic examinations. Therefore, within the field of radiology, there is an ever-increasing demand for deeper knowledge of the anatomy of the regional vasculature and its variations. Variations in the renal vascular system are relatively prevalent in the venous and arterial vessels. For various conditions in which surgical planning is crucial to the success of the procedure, knowledge of this topic is important. The aim of this study was to familiarize the general radiologist with variations in the renal vascular system. To that end, we prepared a pictorial essay comprising multidetector computed tomography images obtained in a series of cases. We show patterns representative of the most common anatomical variations in the arterial blood supply to the kidneys, calling attention to the nomenclature, as well as to the clinical and surgical implications of such variations.