Retropubic

Retropubic is an anatomical term describing structures or spaces located behind the pubic bone. It is most commonly used to refer to the retropubic space, also known as the space of Retzius, and to surgical approaches that access pelvic organs without entering the peritoneal cavity.

The retropubic space lies in the extraperitoneal pelvis between the pubic symphysis and the bladder. It contains loose connective tissue, fat, venous networks, and small arteries and lymphatics that supply the bladder and surrounding structures. The space communicates with adjacent pelvic spaces and is a potential plane through which surgical dissection can occur, particularly in procedures involving the bladder, urethra, and prostate. The exact contents can vary with body habitus and pathology.

Clinical significance arises from its role in various urologic and gynecologic procedures. Retropubic approaches are used to access the bladder and prostate, as in retropubic radical prostatectomy, which aims to remove the prostate through an extraperitoneal route while preserving surrounding tissues. The retropubic route is also employed in pelvic floor surgeries, such as Burch colposuspension, and in procedures for stress urinary incontinence, including retropubic tension-free vaginal tape (TVT). These approaches minimize intraperitoneal exposure but require careful navigation of vascular and neural structures in the space of Retzius.

The term retropubic honors the historical naming of the space of Retzius, named after the Swedish anatomist Anders Retzius. The concept remains central in pelvic surgery, anatomy, and related clinical practice.