Röthlisberger Raphael, Aurore Valerie, Boemke Susanne, Bangerter Hannes, Bergmann Mathias, Thalmann George N, Djonov Valentin
Department of Urology, Inselspital Bern, University of Bern, Switzerland.
Institute of Anatomy, University of Bern, Switzerland.
Clin Anat. 2018 Sep;31(6):788-796. doi: 10.1002/ca.23079. Epub 2018 Oct 24.
The aim of this study was to investigate the nerve supply to the structures in the male lesser pelvis and review its clinical relevance, especially during nerve sparing surgery. Three formalin-embalmed and 16 Thiel-embalmed male hemipelves were used. They were microdissected after repeated treatments with nitric acid diluted 1:10 with milliQ-water. The inferior hypogastric plexus (IHP) is a fan-like structure lateral from the rectum on the fascia of the levator ani. Nerves emerging from the proximal, solid part of the plexus follow the internal iliacal vessels and reach the prostate from dorsolateral. The innervation of the urethra and the corpora cavernosa derives from two origins: one follows the ejaculatory duct and the seminal vesicle, reaching the proximal urethra and the prostate from dorsal; the other follows the inferior vesical artery to reach the prostate from lateral, and then forms the neurovascular bundle on both sides of the prostatic fascia, spreading to the pelvic floor muscles and the corpora cavernosa along with the distal urethra. A connection between the two parts was demonstrated in approximately one third of the samples investigated. The nerve supply to the urinary bladder, the urethra, and the corpora cavernosa emerges mainly from the IHP. The innervation of the proximal urethra and its autonomic muscular structures has a dorsal (ejaculatory duct) and lateral (inferior vesical artery) origin. To maintain good erectile and continence function it is important to save both the dorsal and lateral neurovascular roots. Clin. Anat. 31:788-796, 2018. © 2018 Wiley Periodicals, Inc.
本研究的目的是调查男性小骨盆内结构的神经供应情况，并综述其临床相关性，尤其是在保留神经手术过程中的相关性。使用了3具经福尔马林固定和16具经蒂尔固定的男性半骨盆。在用超纯水按1:10稀释的硝酸反复处理后，对其进行显微解剖。下腹下丛（IHP）是肛提肌筋膜上直肠外侧的扇形结构。从丛的近端实性部分发出的神经沿髂内血管走行，从背外侧到达前列腺。尿道和海绵体的神经支配有两个来源：一个沿射精管和精囊走行，从背侧到达近端尿道和前列腺；另一个沿膀胱下动脉走行，从外侧到达前列腺，然后在前列腺筋膜两侧形成神经血管束，与远端尿道一起延伸至盆底肌肉和海绵体。在大约三分之一的研究样本中证实了这两部分之间的连接。膀胱、尿道和海绵体的神经供应主要来自下腹下丛。近端尿道及其自主肌结构的神经支配有背侧（射精管）和外侧（膀胱下动脉）两个来源。为保持良好的勃起和控尿功能，保留背侧和外侧神经血管根部都很重要。《临床解剖学》2018年第31卷：788 - 796页。© 2018威利期刊公司。
