Novel Anatomic Mapping of Pelvic Plexus at Prostatic and Periprostatic Region on Fresh Frozen Cadaveric Setting

Emre Huri, Mustafa F. Sargon, Ilkan Tatar, Makbule Cisel Aydin, Mehmet Ezer, Figen Soylemezoglu

Abstract


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Purpose: We aimed to investigate the exact localization of neural pathway and the frequency of nerve fibers, which are located in the pelvic facial layers in the prostate and periprostatic regions.
Materials and Methods: We used four fresh frozen cadavers in this trial. Anatomical layers of anterior rectus fascia and abdominal rectus muscle were dissected to reach the retropubic area. Prostate, visceral and parietal pelvic fascia, levator ani muscle and puboprostatic ligaments were identified. Nine tissue samples, each 1x1 cm in size, were obtained from each cadaver and grouped separately. The locations of these samples are as follows. Group G I from 12 o’clock (apical region), G II from right prostatic apex, G III from 2 o’clock, G IV from right far pelvic lateral, G V from 5 o’clock, G VI from 7 o’clock, GVII from left far pelvic lateral, G VIII from 10 o’clock and G IX from left prostatic apex. Nerve distribution, frequency and diameters of these 9 groups were compared to each other.
Results: 36 specimens were obtained from 4 cadavers. Mean number of nerve fibers was 14.1. The number of nerve fibers in each location were not statistically different from each other (P = .9). Mean nerve diameter was 89.1 µm. Mean diameter of nerves was statistically different between groups II, III IV and VI and VIII (P = .001). No difference was seen amongst others.
Conclusion: The distributions of nerve fibers at prostate and peri-prostatic region were homogeneous while the nerve diameters varied amongst the different regions.

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References


Cumhur M, Y. N., Tuncel M: Temel Anatomi, 1 ed: ODTÜ Geliştirme Vakfı Yayıncılık ve İletişim A.Ş., p. 488, 2001

Dauber, W., Feneis, H., Feneis, H. et al.: Pocket atlas of human anatomy founded by Heinz Feneis. In: Thieme ElectronicBook Library, 5th rev. ed. Stuttgart ; New York: Georg Thieme Verlag,, p. 545 p., 2007

Walsh, P. C.: Anatomic radical prostatectomy: evolution of the surgical technique. J Urol, 160: 2418, 1998.

Walsh, P. C.: Radical prostatectomy for the treatment of localized prostatic carcinoma. Urol Clin North Am, 7: 583, 1980

Lepor, H.: A Review of Surgical Techniques for Radical Prostatectomy. Reviews in Urology, 7: S11, 2005.

Walsh, P. C., Marschke, P., Catalona, W. J. et al.: Efficacy of first-generation Cavermap to verify location and function of cavernous nerves during radical prostatectomy: a multiinstitutional evaluation by experienced surgeons. Urology, 57: 491, 2001

Haglind, E., Carlsson, S., Stranne, J. et al.: Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. Eur Urol, 68: 216, 2015.

Alsaid, B., Bessede, T., Diallo, D. et al.: Division of autonomic nerves within the neurovascular bundles distally into corporacavernosa and corpus spongiosum components: immunohistochemical confirmation with three-dimensional reconstruction. Eur Urol, 59: 902, 2011

Clarebrough, E. E., Challacombe, B. J., Briggs, C. et al.: Cadaveric analysis of periprostatic nerve distribution: an anatomical basis for high anterior release during radical prostatectomy? J Urol, 185: 1519, 2011

Walsh, P. C., Donker, P. J.: Impotence following radical prostatectomy: insight into etiology and prevention. J Urol, 128: 492,1982.

Yadav, R., Mukherjee, S., Hermen, M. et al.: Multiphoton microscopy of prostate and periprostatic neural tissue: a promising imaging technique for improving nervesparing prostatectomy. J Endourol, 23: 861,2009

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

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

Ganzer, R., Blana, A., Gaumann, A. et al.: Topographical anatomy of periprostatic and capsular nerves: quantification and computerised planimetry. Eur Urol, 54: 353,2008.

Eichelberg, C., Erbersdobler, A., Michl, U.et al.: Nerve distribution along the prostatic capsule. Eur Urol, 51: 105, 2007

Lee, S. B., Hong, S. K., Choe, G. et al.: Periprostatic distribution of nerves in specimens from non-nerve-sparing radical retropubic prostatectomy. Urology, 72: 878,2008

Kiyoshima, K., Yokomizo, A., Yoshida, T. et al.: Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol, 34: 463, 2004

Costello, A. J., Dowdle, B. W., Namdarian, B. et al.: Immunohistochemical study of the cavernous nerves in the periprostatic region. BJU Int, 107: 1210, 2011




DOI: http://dx.doi.org/10.22037/uj.v14i6.3734


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