Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France.
Eur Urol. 2011 Jun;59(6):902-9. doi: 10.1016/j.eururo.2011.02.031. Epub 2011 Feb 22.
Detailed knowledge of the distribution and distal course of periprostatic nerves is essential to improve functional outcomes (erection and continence) after radical prostatectomy (RP).
To describe the location of nerve fibres within neurovascular bundles (NVBs) and around the prostate by three-dimensional (3D) computer-assisted anatomic dissection (CAAD) in human foetuses and adult cadavers.
DESIGN, SETTING, AND PARTICIPANTS: Serial transverse sections of the pelvic portion were performed in seven human male foetuses and four male adult cadavers. Sections were treated by histologic coloration and neuronal immunolabelling of S100 protein. 3D pelvic reconstruction was achieved with digitised serial sections and WinSurf software.
We evaluated the distribution of nerve fibres within the NVB qualitatively. The distribution of periprostatic nerves was also evaluated quantitatively in the adult specimens.
Periprostatic nerve fibres were dispersed around the prostate on all sides with a significant percentage of these fibres present in the anterior and anterolateral sectors. At the prostate apex and the urethral levels, the NVBs have two divisions: cavernous nerves (CNs) and corpus spongiosum nerves (CSNs). The CNs were a continuation of the anterior and anterolateral fibres around the apex of the prostate, travelling towards the corpora cavernosa. The CSNs were a continuation of the posterolateral NVBs, and they eventually reached the corpus spongiosum. The limitations of this study were the small number of specimens available and the lack of functional information.
The anterolateral position of CNs at the apex of the prostate and the autonomic innervation towards the corpus spongiosum via CSNs indicate possible ways to minimise the effect of prostate surgery on sexual function. The ideal dissection plane should probably include the preservation of the anterolateral tissues and fascias to avoid CN lesions. Anatomic knowledge gained from CAAD pertains directly to proper surgical technique and subsequent recovery of erectile function after RP.
详细了解前列腺周围神经的分布和远端走行对于提高根治性前列腺切除术（RP）后的功能结果（勃起和控尿）至关重要。
通过三维（3D）计算机辅助解剖（CAAD）在人胎儿和成人尸体中描述神经纤维在神经血管束（NVB）内和前列腺周围的位置。
设计、设置和参与者：对 7 例男性胎儿和 4 例男性成人尸体的骨盆部分进行了连续横断切片。对切片进行组织学染色和 S100 蛋白神经元免疫标记。通过数字化连续切片和 WinSurf 软件实现了 3D 骨盆重建。
我们定性评估了 NVB 内神经纤维的分布。还在成人标本中定量评估了前列腺周围神经的分布。
前列腺周围的神经纤维分布在前列腺的所有侧面，其中很大一部分纤维存在于前侧和前外侧区域。在前列腺尖端和尿道水平，NVB 有两个分支：海绵体神经（CN）和海绵体神经（CSN）。CN 是围绕前列腺尖端的前侧和前外侧纤维的延续，向海绵体体部延伸。CSN 是后外侧 NVB 的延续，最终到达海绵体。本研究的局限性在于可用标本数量少且缺乏功能信息。
CN 在前列腺尖端的前外侧位置以及 CSN 通过向海绵体的自主神经支配表明，有可能将前列腺手术对性功能的影响降至最低。理想的解剖平面可能应包括保留前侧组织和筋膜，以避免 CN 损伤。CAAD 获得的解剖知识直接适用于适当的手术技术和 RP 后勃起功能的恢复。
