Abstract
Purpose
To study microscopic patterns of remaining peripheral nerves (PN) after nerve-sparing (NS) radical prostatectomy (RP) and possible consequences for nerve preparation.
Methods
Specimens from 27 patients (7 = non-NSRP, 20 = unilateral NS) were examined. Sections were investigated for PN content by immunoassaying. 120 whole-mounted slides were divided into four sectors, and extracapsular nerves were counted; the mean posterior/anterior ratio was calculated. Calculated ratios were correlated with the respective volumes of prostatic tissue (PV). After dividing the patient cohort into two subgroups, shared by the median value of the posterior/anterior nerve ratios, the absolute PN contents on the anterior surface of the NS sides were compared.
Results
Anatomical posterior nerve percentage in non-NS aspects ranged from 0.0–100.0 to 26.7–94.6% with a mean of 66.60 ± 25.4% and 68.83 ± 16.0% (>/<200 μm, respectively). Individual ratios from two nerve categories showed significant correlation (P < 0.008). Mean posterior ratios were 83.04/79.68 and 39.21/56.00, respectively. After unilateral NS, 3.17-fold (2.25 vs. 0.71 nerves, P = 0.05) and 2.26-fold (21.54 vs. 9.53, P = 0.08) nerve fibers were resected in the anterior area in comparison with type A. After unilateral NS, the variation impact on the anterior nerve content of the NS side could be demonstrated.
Conclusions
The amounts of nerves localized on the anterior prostate after RP vary interindividually. Saving only a minor part of the anterior areas may have an impact on the quantity of excised nerves adjacent to the specimen and impair postoperative functional results. Especially for those patients without a major posterolateral bundle distribution, surgeons should adapt the procedure and start nerve preservation more anteriorly to maximize the probability of satisfactory postoperative functional results.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Eichelberg C, Erbersdobler A, Michl U et al (2007) Nerve distribution along the prostatic capsule. Eur Urol 51:105–110; discussion 110-111
Lunacek A, Schwentner C, Fritsch H et al (2005) Anatomical radical retropubic prostatectomy: ‘curtain dissection’ of the neurovascular bundle. BJU Int 95:1226–1231
Sievert KD, Hennenlotter J, Laible I et al (2008) The periprostatic autonomic nerves-bundle or layer? Eur Urol 54:1109–1116
Ganzer R, Blana A, Gaumann A et al (2008) Topographical anatomy of periprostatic and capsular nerves: quantification and computerised planimetry. Eur Urol 54:353–361
Graefen M, Walz J, Huland H (2006) Open retropubic nerve-sparing radical prostatectomy. Eur Urol 49:38–48
Walz J, Burnett AL, Costello AJ et al (2010) 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 57:179–192
Sievert KD, Hennenlotter J, Laible I et al (2009) The commonly performed nerve sparing total prostatectomy does not acknowledge the actual nerve courses. J Urol 181:1076–1081
Kiyoshima K, Yokomizo A, Yoshida T et al (2004) Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34:463–468
Takenaka A, Kawada M, Murakami G et al (2005) Interindividual variation in distribution of extramural ganglion cells in the male pelvis: a semi-quantitative and immunohistochemical study concerning nerve-sparing pelvic surgery. Eur Urol 48:46–52
Walsh PC, Lepor H, Eggleston JC (1983) Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 4:473–485
Costello AJ, Brooks M, Cole OJ (2004) Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int 94:1071–1076
Takenaka A, Murakami G, Matsubara A et al (2005) Variation in course of cavernous nerve with special reference to details of topographic relationships near prostatic apex: histologic study using male cadavers. Urology 65:136–142
Takenaka A, Murakami G, Soga H et al (2004) Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy. J Urol 172:1032–1035
Eichelberg CEA, Michl U, Graefen M et al (2005) Microscopic analysis of nerve distribution in prostatic specimens. Der Urol Suppl 1:S13 P exp 2.7
Briganti A, Salonia A et al (2006) Potency after radical prostatectomy: from new techniques to better results. EAU-EBU Update Ser 4:33–45
Savera AT, Kaul S, Badani K et al (2006) Robotic radical prostatectomy with the “Veil of Aphrodite” technique: histologic evidence of enhanced nerve sparing. Eur Urol 49:1065–1073; discussion 1073-1074
Kaul S, Bhandari A, Hemal A et al (2005) Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology 66:1261–1265
Zvara P, Spiess PE, Merlin SL et al (1996) Neurogenic erectile dysfunction: the course of nicotinamide adenine dinucleotide phosphate diaphorase-positive nerve fibers on the surface of the prostate. Urology 47:146–151
Wright JL, Newhouse JH, Laguna JL et al (2004) Localization of neurovascular bundles on pelvic CT and evaluation of radiation dose to structures putatively involved in erectile dysfunction after prostate brachytherapy. Int J Radiat Oncol Biol Phys 59:426–435
Fried NM, Rais-Bahrami S, Lagoda GA et al (2007) Imaging the cavernous nerves in the rat prostate using optical coherence tomography. Lasers Surg Med 39:36–41
Lee SE, Hong SK, Han JH et al (2007) Significance of neurovascular bundle formation observed on preoperative magnetic resonance imaging regarding postoperative erectile function after nerve-sparing radical retropubic prostatectomy. Urology 69:510–514
Conflict of interest
The authors certify that there are no actual or potential conflicts of interests in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
B. Amend and J. Hennenlotter equally contributed to this work.
Rights and permissions
About this article
Cite this article
Amend, B., Hennenlotter, J., Kuehs, U. et al. Prostatic peripheral nerve distribution may impact the functional outcome of nerve-sparing prostatectomy. World J Urol 31, 377–382 (2013). https://doi.org/10.1007/s00345-011-0791-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-011-0791-z