The Periprostatic Autonomic Nerves—Bundle or Layer?

Sievert, Karl‐Dietrich; Hennenlotter, Jörg; Laible, I.; Amend, Bastian; Schilling, David; Anastasiadis, Aristotelis G.; Kuehs, Ursula; Nagele, Udo; Stenzl, Arnulf

doi:10.1016/j.eururo.2008.06.007

Cited by 67 publications

(41 citation statements)

References 30 publications

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“…Orientation of the prostatectomy specimen was specified by counterclockwise numbering around the perimeter with reference to the urethral opening as the apex, and 6 o'clock and 12 o'clock were numbered to the posterior and anterior sides, respectively. The prostatic nerves, which course along the posterolateral side of prostate, are known to be in higher density and size [9,10], and more responsible for erectile function [13] compared to the ones in the anterior side. Three different orientation sites at 3, 5, and 12 o'clock were imaged in individual specimens.…”

Section: Sample Preparationsmentioning

confidence: 99%

“…Prostatic nerves and blood vessels forming neurovascular bundle (NVB) are situated in the space of fascia, and surgeons dissect the interfascial planes during NSRP. NVBs are usually distributed more in the posterolateral side of prostate, and less in the anterior side of prostate [9,10]. Three different sites of the prostatectomy specimens indicated in Fig.…”

Section: Ps-oct Imaging Of Human Prostatectomy Specimens Ex Vivomentioning

confidence: 99%

“…The distance between CNs and prostate surface varies depending on different areas from several hundreds of micrometers to a few centimeters apart. The current method of identifying CNs during NSRP procedure is based on their visual appearance and general understanding of the anatomy [4][5][6][7][8][9][10]. An electrophysiological testing method such as electromyographic (EMG) stimulation [11][12][13] and various imaging methods have been developed and are under investigation to provide better identification of CNs [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Visualization of prostatic nerves by polarization-sensitive optical coherence tomography

Yoon

Jeon

Park

et al. 2016

Biomed. Opt. Express

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Preservation of prostatic nerves is critical to recovery of a man's sexual potency after radical prostatectomy. A real-time imaging method of prostatic nerves will be helpful for nerve-sparing radical prostatectomy (NSRP). Polarization-sensitive optical coherence tomography (PS-OCT), which provides both structural and birefringent information of tissue, was applied for detection of prostatic nerves in both rat and human prostate specimens, ex vivo. PS-OCT imaging of rat prostate specimens visualized highly scattering and birefringent fibrous structures superficially, and these birefringent structures were confirmed to be nerves by histology or multiphoton microscopy (MPM). PS-OCT could easily distinguish these birefringent structures from surrounding other tissue compartments such as prostatic glands and fats. PS-OCT imaging of human prostatectomy specimens visualized two different birefringent structures, appearing fibrous and sheet-like. The fibrous ones were confirmed to be nerves by histology, and the sheet-like ones were considered to be fascias surrounding the human prostate. PS-OCT imaging of human prostatectomy specimens along the perimeter showed spatial variation in the amount of birefringent fibrous structures which was consistent with anatomy. These results demonstrate the feasibility of PS-OCT for detection of prostatic nerves, and this study will provide a basis for intraoperative use of PS-OCT. References and links1. P. C. Walsh and P. J. Donker, "Impotence following radical prostatectomy: insight into etiology and prevention," J. Urol. 128(3), 492-497 (1982). 2. F. Montorsi, A. Salonia, N. Suardi, A. Gallina, G. Zanni, A. Briganti, F. Deho', R. Naspro, E. Farina, and P.Rigatti, "Improving the preservation of the urethral sphincter and neurovascular bundles during open radical retropubic prostatectomy," Eur. Urol. 48(6), 938-945 (2005 524-535 (2015).

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Section: Sample Preparationsmentioning

confidence: 99%

Section: Ps-oct Imaging Of Human Prostatectomy Specimens Ex Vivomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Visualization of prostatic nerves by polarization-sensitive optical coherence tomography

Yoon

Jeon

Park

et al. 2016

Biomed. Opt. Express

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“…[4][5][6] Sievert and colleagues report that bilateral nerve-sparing prostatectomy for localized prostate cancer provides the possibility of preserving approximately 55% of periprostatic nerve fibres focused on the posterolateral location and 80% to 90% at the apex. 6 Regardless of whether optical magnification, intraoperative nerve stimulation, or adaptations to surgical tissue handling/technique of nerve sparing are used, the actual course of nerve fibres is difficult to identify and limits optimizing clinical outcomes (both continence and erectile function) that rely upon neuronal recovery post-injury and intact nerve signaling to the sphincter or corpora.…”

mentioning

confidence: 99%

“…6 Regardless of whether optical magnification, intraoperative nerve stimulation, or adaptations to surgical tissue handling/technique of nerve sparing are used, the actual course of nerve fibres is difficult to identify and limits optimizing clinical outcomes (both continence and erectile function) that rely upon neuronal recovery post-injury and intact nerve signaling to the sphincter or corpora. 5 The endogenous response and potential for exogenous neuromodulation of the injured nerves and the interface between nerve and sphincter post-radical prostatectomy remains a physiologic "black box." While with further research we will likely attain more detailed neuroanatomical understanding, all surgical approaches inherently result in tissue disruption and patient outcomes will be best optimized by minimizing collateral damage and the development of novel neurotherapeutics.…”

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confidence: 99%

Improving outcomes post-radical prostatectomy: nerve-sparing status and urinary continence

Morash

Cagiannos

Bella

2013

CUAJ

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P ostoperative urinary incontinence following radical prostatectomy is an increasingly important health outcome. In an era in which the burden of treatment for prostate cancer is being closely examined in terms of harm from potential overtreatment, it is important to study ways to reduce the incidence of this complication. Incontinence often results in significant stress and anxiety for patients and their families, and a significant use of resources, including incontinence products, further surgical intervention and patient and surgeon time. For most individuals, incontinence has a greater negative impact on quality of life than even erectile dysfunction. Several prior publications have looked at whether nerve sparing at radical prostatectomy contributes to continence rates, albeit with inconsistent results. 1 Limitations of this literature include mostly retrospective data collection, the lack of an objective method of measuring the quality of nerve preservation itself, variable definitions of continence and its pathophysiology, lack of baseline data and a lack of objective measures of urethral and sphincter trauma intra-operatively.In the current study, Toren and colleagues 2 are to be commended for the prospective use of a validated, patientreported tool for continence outcomes, including preoperative baseline measures. However, the variable being investigated is whether nerve sparing was performed, unilateral or bilateral, and the subsequent impact on patient continence. Key data points, including nerve sparing, were obtained retrospectively based on the surgeon's description in the patient record. The surgeon's judgment may not actually correlate well with actual nerve preservation. In a study by Kaiho and colleagues, 3 electrophysiological assessment of macroscopically preserved nerves were reclassified as not intact in 20% of cases, and in a third of cases the surgeon's assessment of unilateral, bilateral or nonnerve sparing was not supported by the electrophysiological assessment. Therefore, just as we require patient-reported outcomes measures, perhaps we should also require an objective metric for whether nerve preservation, unilateral or bilateral or non-nerve-sparing, was actually carried out.Recent anatomic studies have resulted in a re-examination of the "dorsolateral neurovascular bundle" concept, as topography and nerve quantification studies confirm wide variability of periprostatic nerve distribution. [4][5][6] Sievert and colleagues report that bilateral nerve-sparing prostatectomy for localized prostate cancer provides the possibility of preserving approximately 55% of periprostatic nerve fibres focused on the posterolateral location and 80% to 90% at the apex. 6 Regardless of whether optical magnification, intraoperative nerve stimulation, or adaptations to surgical tissue handling/technique of nerve sparing are used, the actual course of nerve fibres is difficult to identify and limits optimizing clinical outcomes (both continence and erectile function) that rely upon neuronal recovery post...

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Nerve Visualization using Phenoxazine‐Based Near‐Infrared Fluorophores to Guide Prostatectomy

Wang,

Montaño,

Masillati

et al. 2023

Advanced Materials

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Fluorescence‐guided surgery (FGS) is poised to revolutionize surgical medicine through near‐infrared (NIR) fluorophores for tissue‐ and disease‐specific contrast. Clinical open and laparoscopic FGS vision systems operate nearly exclusively at NIR wavelengths. However, tissue‐specific NIR contrast agents compatible with clinically available imaging systems are lacking, leaving nerve tissue identification during prostatectomy a persistent challenge. Here, we show that combining drug‐like molecular design concepts and fluorophore chemistry enabled the production of a library of NIR phenoxazine‐based fluorophores for intraoperative nerve‐specific imaging. The lead candidate readily delineated prostatic nerves in the canine and iliac plexus in the swine models using the clinical da Vinci Surgical System that has been popularized for minimally invasive prostatectomy procedures. These results demonstrate the feasibility of molecular engineering of NIR nerve‐binding fluorophores for ready integration into the existing surigical workflow, paving the path for clinical translation to reduce morbidity from nerve injury for prostate cancer patients.This article is protected by copyright. All rights reserved

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The Periprostatic Autonomic Nerves—Bundle or Layer?

Cited by 67 publications

References 30 publications

Visualization of prostatic nerves by polarization-sensitive optical coherence tomography

Visualization of prostatic nerves by polarization-sensitive optical coherence tomography

Improving outcomes post-radical prostatectomy: nerve-sparing status and urinary continence

Nerve Visualization using Phenoxazine‐Based Near‐Infrared Fluorophores to Guide Prostatectomy

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