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Prostate Neurovascular Anatomy and Its Impact on Nerve-Sparing RALP

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Robotic Urologic Surgery

Abstract

A detailed understanding of the neurovascular anatomy of the prostate is integral to the performance of high-quality nerve sparing during radical prostatectomy. Advances in pelvic anatomical knowledge have dramatically improved the safety and functional outcomes of what was previously an unacceptably morbid procedure. This chapter provides an overview of the relevant anatomy and the practical application of anatomical principles for optimization of functional outcomes during nerve-sparing robot-assisted radical prostatectomy.

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References

  1. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128:492–7.

    CAS  PubMed  Google Scholar 

  2. Muller J. Über die organischen Nerven der erectilen männlichen Geschlectsorgane desMenschen und der Säugethiere. (Concerning the autonomic nerves of the male erectile genital organs of man and mammals.). Berlin: F. Dummler; 1836.

    Google Scholar 

  3. Costello AJ, Brooks M, Cole OJ. Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004;94:1071–6.

    PubMed  Google Scholar 

  4. Costello AJ, Dowdle BW, Namdarian B, Pedersen J, Murphy DG. Immunohistochemical study of the cavernous nerves in the periprostatic region. BJU Int. 2011;107:1210–5.

    PubMed  Google Scholar 

  5. Ficarra V, Novara G, Ahlering TE, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012;62:418–30.

    PubMed  Google Scholar 

  6. Walz J, Burnett AL, Costello AJ, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010;57:179–92.

    PubMed  Google Scholar 

  7. Raychaudhuri B, Cahill D. Pelvic fasciae in urology. Ann R Coll Surg Engl. 2008;90:633–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Rassweiler J, Laguna P, Chlosta P, et al. ESUT expert group on laparoscopy proposes uniform terminology during radical prostatectomy: we need to speak the same language. Eur Urol. 2013;64:97–100.

    PubMed  Google Scholar 

  9. Tewari A, Peabody JO, Fischer M, et al. An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003;43:444–54.

    PubMed  Google Scholar 

  10. McNeal JE. The zonal anatomy of the prostate. Prostate. 1981;2:35–49.

    CAS  PubMed  Google Scholar 

  11. Myers RP. Detrusor apron, associated vascular plexus, and avascular plane: relevance to radical retropubic prostatectomy--anatomic and surgical commentary. Urology. 2002;59:472–9.

    PubMed  Google Scholar 

  12. Li X, Wu J, Cai Q, et al. The distribution pattern of periprostatic neurovascular bundles examined with successive celloidin slices. BMC Urol. 2021;21:6.

    PubMed  PubMed Central  Google Scholar 

  13. Myers RP. Gross and applied anatomy of the prostate. In: Kantoff PW, Rarroll PR, D’Amico AV, editors. Prostate cancer principles and practice. Philadelphia: Lippincott Williams & Wilkins; 2002.

    Google Scholar 

  14. Mauroy B, Demondion X, Drizenko A, et al. The inferior hypogastric plexus (pelvic plexus): its importance in neural preservation techniques. Surg Radiol Anat. 2003;25:6–15.

    CAS  PubMed  Google Scholar 

  15. Baader B, Herrmann M. Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat. 2003;16:119–30.

    CAS  PubMed  Google Scholar 

  16. Reeves F, Battye S, Borin JF, Corcoran NM, Costello AJ. High-resolution map of somatic periprostatic nerves. Urology. 2016;97:160–5.

    PubMed  Google Scholar 

  17. Zlotta AR, Roumeguère T, Ravery V, et al. Is seminal vesicle ablation mandatory for all patients undergoing radical prostatectomy? Eur Urol. 2004;46:42–9.

    PubMed  Google Scholar 

  18. Kiyoshima K. Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol. 2004;34:463–8.

    PubMed  Google Scholar 

  19. Ganzer R, Stolzenburg J-U, Wieland WF, Bründl J. Anatomic study of periprostatic nerve distribution: immunohistochemical differentiation of parasympathetic and sympathetic nerve fibres. Eur Urol. 2012;62:1150–6.

    PubMed  Google Scholar 

  20. Paick JS, Donatucci CF, Lue T. Anatomy of cavernous nerves distal to prostate: microdissection study in adult male cadavers. Urology. 1993;42:145–9.

    CAS  PubMed  Google Scholar 

  21. Rocco B, Cozzi G, Spinelli MG, Coelho RF, Patel VR. Posterior musculofascial reconstruction after radical prostatectomy: a systematic review of the literature. Eur Urol. 2012.

    Google Scholar 

  22. Narayan P, Konety B, Aslam K, Aboseif S, Blumenfeld W, Tanagho E. Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol. 1995;153:337–41.

    CAS  PubMed  Google Scholar 

  23. Takenaka A, Hara R, Soga H, Murakami G, Fujisawa M. A novel technique for approaching the endopelvic fascia in retropubic radical prostatectomy, based on an anatomical study of fixed and fresh cadavers. BJU Int. 2005;95:766–71.

    PubMed  Google Scholar 

  24. Clegg EJ. The arterial supply of the human prostate and seminal vesicles. J Anat. 1955;89:209–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Secin FP, Touijer K, Mulhall J, Guillonneau B. Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol. 2007;51:1229–35.

    PubMed  Google Scholar 

  26. Droupy S, Benoit G, Giuliano F, Jardin A. Penile arteries in humans origin-distribution-variations. Surg Radiol Anat. 1997;19:161–7.

    CAS  PubMed  Google Scholar 

  27. Breza J, Aboseif S, Lue T, Tanagho EA. Detailed anatomy of penile neurovascular structures: surgical significance. J Urol. 1989;141:437–43.

    CAS  PubMed  Google Scholar 

  28. Droupy S, Hessel A, Benoit G, Blanchet P, Jardin A, Giuliano F. Assessment of the functional role of accessory pudendal arteries in erection by transrectal color Doppler ultrasound. JURO. 1999;162:1987–91.

    CAS  Google Scholar 

  29. Myers RP. Anatomical variation of the superficial preprostatic veins with respect to radical retropubic prostatectomy. J Urol. 1991;145:992–3.

    CAS  PubMed  Google Scholar 

  30. Reiner WG, Walsh PC. An anatomical approach to the surgical management of the dorsal vein and Santorini’s plexus during radical retropubic surgery. J Urol. 1979;121:198–200.

    CAS  PubMed  Google Scholar 

  31. Power NE, Silberstein JL, Kulkarni GS, Laudone VP. The dorsal venous complex (DVC): dorsal venous or dorsal vasculature complex? Santorini's plexus revisited. BJU Int. 2011;108:930–2.

    PubMed  PubMed Central  Google Scholar 

  32. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA. 1994;271:368–74.

    CAS  PubMed  Google Scholar 

  33. Kaul S, Bhandari A, Hemal A, Savera A, Shrivastava A, Menon M. Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology. 2005;66:1261–5.

    PubMed  Google Scholar 

  34. Tewari A, Srivastava A, Sooriakumaran P, Grover S, Dorsey P, Leung R. Technique of traction-free nerve-sparing robotic prostatectomy: delicate tissue handling by real-time penile oxygen monitoring. Int J Impot Res. 2012;24:11–9.

    CAS  PubMed  Google Scholar 

  35. Schatloff O, Chauhan S, Sivaraman A, Kameh D, Palmer K, Patel VR. Anatomic grading of nerve sparing surgery during robot-assisted radical prostatectomy. Eur Urol. 2012;61:796–802.

    PubMed  Google Scholar 

  36. Eichelberg C, Erbersdobler A, Haese A, et al. Frozen section for the management of intraoperatively detected palpable tumor lesions during nerve-sparing scheduled radical prostatectomy. Eur Urol. 2006;49:1011–6. discussion 1016–1018

    PubMed  Google Scholar 

  37. Kakiuchi Y, Choy B, Gordetsky J, et al. Role of frozen section analysis of surgical margins during robot-assisted laparoscopic radical prostatectomy: a 2608-case experience. Hum Pathol. 2013;44:1556–62.

    PubMed  Google Scholar 

  38. Lepor H, Kaci L. Role of intraoperative biopsies during radical retropubic prostatectomy. Urology. 2004;63:499–502.

    PubMed  Google Scholar 

  39. Dinneen E, Haider A, Allen C, et al. NeuroSAFE robot-assisted laparoscopic prostatectomy versus standard robot-assisted laparoscopic prostatectomy for men with localised prostate cancer (NeuroSAFE PROOF): protocol for a randomised controlled feasibility study. BMJ Open. 2019;9:e028132.

    PubMed  PubMed Central  Google Scholar 

  40. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta-analysis. Eur Urol. 2015;68:692–704.

    PubMed  Google Scholar 

  41. Hollabaugh J, Robert S, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology. 1997;491997:426–34.

    Google Scholar 

  42. Akita K, Sakamoto H, Sato T. Origins and courses of the nervous branches to the male urethral sphincter. Surg Radiol Anat. 2003;25:387–92.

    CAS  PubMed  Google Scholar 

  43. Karam I, Droupy S, Abd-Alsamad I, et al. The precise location and nature of the nerves to the male human urethra: histological and immunohistochemical studies with three-dimensional reconstruction. Eur Urol. 2005;48:858–64.

    PubMed  Google Scholar 

  44. Reeves F, Everaerts W, Murphy DG, et al. Stimulation of the neurovascular bundle results in rhabdosphincter contraction in a proportion of men undergoing radical prostatectomy. Urology. 2016;87:133–9.

    PubMed  Google Scholar 

  45. O’Donnell PD, Finan BF. Continence following nerve-sparing radical prostatectomy. J Urol. 1989;142:1227–8.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. The Royal Melbourne Hospital, Parkville, Australia

    Anthony J. Costello

  2. Department of Surgery, University of Melbourne, Melbourne, Australia

    Anthony J. Costello

  3. Australian Medical Robotics Academy, North Melbourne, VIC, Australia

    Anthony J. Costello

  4. The Urology Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom

    Fairleigh Reeves

Authors
  1. Anthony J. Costello
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  2. Fairleigh Reeves
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Editor information

Editors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA

    Peter Wiklund

  2. Department of Urology, ORSI Academy, Aalst, Belgium

    Alexandre Mottrie

  3. Pediatric Urology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Mohan S Gundeti

  4. Urology, Global Robotics Institute, Celebration, FL, USA

    Vipul Patel

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Costello, A.J., Reeves, F. (2022). Prostate Neurovascular Anatomy and Its Impact on Nerve-Sparing RALP. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_14

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  • DOI: https://doi.org/10.1007/978-3-031-00363-9_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-00362-2

  • Online ISBN: 978-3-031-00363-9

  • eBook Packages: MedicineMedicine (R0)

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