Three-dimensional ultrasound and magnetic resonance imaging of pelvic anatomy: Potential for complications from minimally invasive procedures

Objective: Several new minimally invasive therapies have recently been popu larized for both malignant and benign prostate disorders, including interst itial implantation of radioactive seeds and high-radiofrequency wires, cryo ablation, transurethral thermotherapy, and laser prostatectomy, Complicatio ns can be incurred during the various procedures, often as a result of inju ry to adjacent anatomic structures. Some of the complications are inadverte nt, whereas others are inherent in the particular treatment process. We hop e to increase awareness and understanding of some of the potential complica tions, Methods and Materials: Magnetic resonance (MR) and three-dimensional transr ectal ultrasonography (TRUS) imaging were utilized to illustrate the releva nt pelvic anatomy in, respectively, a healthy volunteer and four patients u ndergoing evaluation for prostate symptoms, In addition, data from the Visi ble Human dataset (the Visible Human Project is part of the National Librar y of Medicine 1986 Long-Range Plan) were used. Results: The potential complications relating to urinary sphincter and anal sphincter control, sexual function, pelvic musculature, and pelvic nerve p hysiology could be explained on the basis of the MR and TRUS findings using cryoablation for illustrative purposes. Conclusion: A clear understanding of the relevant anatomy and physiology is essential for the physician to provide patient counseling preoperatively r egarding anticipated sequelae and to avoid preventable intraoperative compl ications related to minimally invasive therapeutic procedures for the prost ate.