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- Title
233: Anatomy of the nerves around the prostate apex: Implications for recovery of sexual function and continence.
- Authors
Rao, Sandhya; Leung, Robert A.; Yadav, Rajiv A.; Jhaveri, Jay K.; Tan, Gerald Y.; Takenaka, Atsushi; Bartsch, Georg; Tewari, Ashutosh K.
- Abstract
Introduction: The nerves for erection, orgasm and continence intermingle very closely at the prostatic apex. We sought to elucidate the neuroanatomic lattice of this region, to improve sexual and continence outcomesfollowing robotic-assisted prostatectomy. Methods: We performed anatomic dissections in 5 fresh cadavers and reviewed the peri-apical microscopic anatomy in another 20 non nerve-sparing radical prostatectomy specimens. Gross and microscopic images were captured using a digital imaging device and used for this paper. Nerves were stained using a special S100 neural stain and counted during histopathology. Results: We identified the complex neural plexus around the prostatic apex which occupied a postero-lateral plane and sent branches to the cavernous nerve and sphincter. This plexus was located around the veins and was very delicate and likely to getting damaged by traction, dissection, heat, clips and sutures. An anatomic map has been created to prevent such injuries and correlations have been made with matching superimposing surgical images. Conclusions: Our anatomic study has yielded a clearer understandiing of the periapical neural meshwork. We discuss strategies for preventing injury to this delicate scaffold of nerves to improve surgical outcomes.
- Subjects
NEUROANATOMY; PROSTATE; HUMAN sexuality; PENILE erection; MALE orgasm; PROSTATECTOMY; SURGERY
- Publication
Indian Journal of Urology, 2008, Vol 24, pS127
- ISSN
0970-1591
- Publication type
Article