Neuroanatomical Study of Periprostatic Nerve Distributions Using Human Cadaver Prostate

Abstract

We investigated the distribution and navigation of periprostatic nerve fibers and constructed a 3-dimensional model of nerve distribution. A total of 5 cadaver specimens were serially sectioned in a transverse direction with 0.5 cm intervals. Hematoxylineosin staining and immunohistochemical staining were then performed on whole-mount sections. Three representative slides from the base, mid-part, and apex of each prostate were subsequently divided into 4 sectors: two lateral, one ventral, and one dorsal (rectal) part. The number of nerve fibers, the distance from nerve fiber to prostate capsule, and the nerve fiber diameters were analyzed on each sector from the representative slides by microscopy. Periprostatic nerve fibers revealed a relatively even distribution in both lateral and dorsal parts of the prostate. There was no difference in the distances from the prostate capsule to nerve fibers. Nerve fibers in the ventral area were also thinner as compared to other areas. In conclusion, periprostatic nerve fibers were observed to be distributed evenly in the periprostatic area, with the exception of the ventral area. As the number of nerve fibers on the ventral part is fewer in comparison, an excessive high up incision is insignificant during the nerve-sparing radical prostatectomy.

Pathological confirmation of nerve‐sparing types performed during robot‐assisted radical prostatectomy (RARP)

“… identified, in addition to the main NVB on the posterolateral border of the prostate, nerve branches running between the prostatic fascia and the LPF. The neurovascular structures tend to be located posterolaterally, but may not always form a bundle . As such, to improve functional outcomes after RP, surgeons try to preserve the fascia structures around the prostate much more.…”

“…In several reports it was recognised that the NVB is situated in a localised space in about half of cases, whereas in the rest it is sparsely spread to the lateral aspect, without definite bundle formation. This fact makes nerve preservation difficult to predict and it may be one of the primary reasons for variability in postoperative functional patient outcomes.…”

Electrical stimulation vs. pulsed and continuous-wave optical stimulation of the rat prostate cavernous nerves, in vivo

“…Due to their microscopic nature and close proximity to the prostate gland (a mean distance of only 2.8 mm [1]), the CNs are at risk of injury during surgery. The location, extent, and path of the CNs also vary among patients [2][3][4][5][6][7][8][9]. These factors contribute to widely variable sexual potency rates (9-86%) following surgery [10].…”

Novel methods for mapping the cavernous nerves during radical prostatectomy

“…2 Findings of anatomical studies also suggest that cavernous nerves might have more extensive branching along the prostate surface than originally thought, and that our current understanding of the location, extent and course of cavernous nerves is limited. [3][4][5][6][7][8][9][10] Individual nerve fibres can range in diam eter from 200-400 μm and the number of fibres is widely variable, depending on anatomical location (ventral, dorsal, or lateral); fibre bundles that have diameters of up to a few millimetres can also occur. 7,10 Improvements in the identification of cavernous nerves during surgery would aid their preservation and improve postoperative sexual function, resulting in direct beneficial effects on patients' quality of life.…”