Bessede Thomas, Sooriakumaran Prasanna, Takenaka Atsushi, Tewari Ash
Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA.
U1195, Univ. Paris Sud, INSERM, Université Paris-Saclay, 94270, Le Kremlin-Bicetre, France.
World J Urol. 2017 Apr;35(4):549-565. doi: 10.1007/s00345-016-1901-8. Epub 2016 Aug 2.
To review the anatomical facts of urethral sphincter (US) innervation discovered over the last three decades and to determine the implications for continence recovery after radical prostatectomy (RP).
Using the PubMed database, we searched for peer-reviewed articles in English between January 1985 and September 2015, with the following terms: 'urethral sphincter,' 'urethral rhabdosphincter,' 'urinary continence and nerve supply' and 'neuroanatomy and nerve sparing.' The anatomical methodology, number of bodies examined, data, figures, relevant facts and text were analyzed.
Seventeen articles on 254 anatomical subjects were reviewed. Coexisting pathways were described in every article. Dissection, histology, simulation or electron microscopy evidence supported arguments for somatic and autonomic pathways. From the most to the least substantiated, somatic sphincteric fibers were described extra- or intrapelvic as: direct from the distal pudendal nerve (PuN), recurrent from the dorsal nerve of the penis, from the proximal PuN with an intrapelvic course, extrapudendal somatic fibers dispersed among autonomic pelvic fibers. From the pelvic plexus, or from the neurovascular bundles, autonomic fibers to the US have been described in 13 of the reviewed articles, with at least each of the available anatomical methods.
Because continence depends on a number of factors, it is challenging to delineate the specific impact of periprostatic nerve sparing on continence, but the anatomical data suggest that RP surgeons should steer toward the preservation and protection of these nerves whenever possible.
回顾过去三十年中发现的尿道括约肌（US）神经支配的解剖学事实，并确定其对根治性前列腺切除术（RP）后控尿恢复的影响。
利用PubMed数据库，我们检索了1985年1月至2015年9月期间以英文发表的同行评审文章，检索词如下：“尿道括约肌”、“尿道横纹括约肌”、“尿失禁与神经供应”以及“神经解剖学与神经保留”。对解剖学方法、检查的尸体数量、数据、图表、相关事实和文本进行了分析。
对17篇关于254个解剖学研究对象的文章进行了综述。每篇文章都描述了共存的神经通路。解剖、组织学、模拟或电子显微镜证据支持了躯体和自主神经通路的观点。从证据最充分到最不充分，躯体括约肌纤维在盆腔外或盆腔内的描述如下：直接来自阴部神经远端（PuN）、阴茎背神经的返支、走行于盆腔内的阴部神经近端、分散于自主盆腔纤维中的阴部外躯体纤维。在13篇综述文章中，通过至少每种可用的解剖学方法，都描述了从盆腔丛或神经血管束到尿道括约肌的自主神经纤维。
由于控尿取决于多种因素，因此很难确定前列腺周围神经保留对控尿的具体影响，但解剖学数据表明，RP外科医生应尽可能朝着保留和保护这些神经的方向努力。
