Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France.
Curr Opin Urol. 2011 May;21(3):173-8. doi: 10.1097/MOU.0b013e3283449d6d.
New insights in the anatomy of the prostate and the surrounding tissue evolve the technique of radical prostatectomy for the treatment of prostate cancer.
Regarding the course of the erectile nerves along the prostate, recent studies confirmed the presence of parasympathetic pro-erectile nerve fibers at the anterolateral aspect of the prostate. Another study of intraoperative electrostimulation of those nerves confirmed an increase in intracavernosal pressure by stimulations between the 1 and 3 o'clock position. Therefore, it is very likely that these anterior nerve fibers have an effect on erectile function. Regarding the urethral sphincter in the male, a study showed no attachment of the external sphincter to the levator ani muscle, probably resulting in an absence of a levator ani support to the continence mechanism. The male urinary sphincter seems to be in isolation responsible for urinary continence.
The nerve fibers at the anterolateral aspect of the prostate seem to participate in erectile function, which renders the concept of a high anterior release during nerve sparing beneficial. The isolated urinary sphincter mechanism results in the need to conserve as much urethral length as possible during radical prostatectomy to avoid urinary incontinence.
前列腺及其周围组织解剖学的新见解使根治性前列腺切除术治疗前列腺癌的技术不断发展。
关于勃起神经在前列腺中的走行，最近的研究证实，前列腺的前外侧存在副交感神经原勃起神经纤维。另一项关于这些神经术中电刺激的研究证实，刺激 1 点到 3 点之间可增加海绵体内压。因此，这些前侧神经纤维很可能对勃起功能有影响。关于男性尿道括约肌，一项研究表明，外括约肌与肛提肌没有附着，可能导致肛提肌对控尿机制没有支持。男性尿控括约肌似乎独立负责尿控。
前列腺前外侧的神经纤维似乎参与勃起功能，这使得在保留神经时进行高前释放的概念有益。孤立的尿控机制导致在根治性前列腺切除术中需要尽可能保留较长的尿道长度，以避免尿失禁。
