Ex-vivo functional and mechanical assessment of human endopelvic fascia in men undergoing radical prostatectomy.

Abstract

Background: There are limited studies describing the contractile function of the endopelvic fascia in the male pelvis and the role of the endopelvic fascia in the pathophysiology of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We performed ex-vivo functional studies and described the histology of the endopelvic fascia.

Methods: Endopelvic fascia specimens were collected from patients (n = 10) undergoing robotic prostatectomy. Two fascia strips (2 × 1 cm) from each side of the pelvis were excised and immediately used for functional studies. Each strip was cut into one centimeter piece for studying. One strip was suspended in organ baths and contractile response to potassium chloride (100 mM), and carbachol (0.01 µM, 1 µM, 10 µM, 20 µM) assessed. The second strip was used for histology with hematoxylin and eosin (H&E) and Masson-trichrome staining for elastic fibers, collagen and smooth muscle or stress strain testing.

Results: Twenty endopelvic fascia samples from 10 patients were analyzed. Only two specimens showed a contractile response to potassium chloride. The remaining 18 specimens exhibited no contractile response. Histologically, the fascia consisted mainly of fibrous connective tissue with minor adipose tissue and occasional smooth muscle, along with arterioles. Tensile testing revealed nonlinear behavior, with a nominal stiffness estimated at 0.765 MPa after the toe region.

Conclusions: The male endopelvic fascia lacks contractile response to potassium chloride and cholinergic stimulation, resembling other human fasciae histologically. It's improbable that it contributes to male LUTS but may impede prostate expansion mechanically due to its fibrous nature.