Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon

Background: The development and anatomy of Denonvilliers' fascia have been controversial for many years and confusion exists about its operative appea rance. Better appreciation of this poorly understood anatomy, and its signi ficance for impotence after rectal dissection, may lead to further function al improvements in pelvic surgery. Method: A literature review of Denonvilliers' fascia and impotence after pe lvic rectal surgery was undertaken. Results: Denonvilliers' fascia has no macroscopically discernible layers. T he so-called posterior layer refers to the fascia propria of the rectum. Th e incidence of erectile and ejaculatory dysfunction after rectal excision i s high in older patients, and when performed for rectal cancer. There is no consensus about the relationship of Denonvilliers' fascia to the plane of anterior dissection for rectal cancer. Conclusion: Colorectal surgeons should focus on the important anatomy betwe en the rectum and the prostate to improve functional outcomes after rectal excision. A classification of the available anterior dissection planes is p roposed. Surgeons should be encouraged to document the plane used as well a s outcome in terms of sexual function.