Immunohistochemical study of the cavernous nerves in the periprostatic region
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable...
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| Published in | BJU international Vol. 107; no. 8; pp. 1210 - 1215 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.04.2011
Wiley-Blackwell |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1464-4096 1464-410X 1464-410X |
| DOI | 10.1111/j.1464-410X.2010.09711.x |
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| Abstract | Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable advances made in this area since the original dissections of Walsh and Donker almost thirty years ago, the precise location and function of these structures remains uncertain. The topic is of tremendous importance as we continue to refine surgical techniques to allow men the maximum opportunity to recover erectile function following radical prostatectomy. Yet many of these surgical refinements are not based on definitive knowledge of the relevant anatomy and clearly more knowledge is required.
For the first time, we have not just characterized the quantitative nature of the periprostatic nerves, but we also offer some insight into the likely functional nature of these nerves by selectively staining the sympathetic and parasympathetic nerves using immunohistochemical methods.
OBJECTIVE
• To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate.
MATERIALS AND METHODS
• Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred.
• The fascial architecture of the neurovascular bundle (NVB) was also quantified.
RESULTS
• Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o’clock level. At the base, mid, and apex of prostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively.
• Sympathetic nerves found above the 3 to 9 o’clock level represented ≈15% of the total number of nerves.
• When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments.
CONCLUSIONS
• A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves.
• There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB.
• The presence of distinct fascial compartments in the NVB is also confirmed. |
|---|---|
| AbstractList | Study Type - Therapy (case series)Level of Evidence4 What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable advances made in this area since the original dissections of Walsh and Donker almost thirty years ago, the precise location and function of these structures remains uncertain. The topic is of tremendous importance as we continue to refine surgical techniques to allow men the maximum opportunity to recover erectile function following radical prostatectomy. Yet many of these surgical refinements are not based on definitive knowledge of the relevant anatomy and clearly more knowledge is required. For the first time, we have not just characterized the quantitative nature of the periprostatic nerves, but we also offer some insight into the likely functional nature of these nerves by selectively staining the sympathetic and parasympathetic nerves using immunohistochemical methods. times To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate. times Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred. times The fascial architecture of the neurovascular bundle (NVB) was also quantified. times Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o'clock level. At the base, mid, and apex of prostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively. times Sympathetic nerves found above the 3 to 9 o'clock level represented approximately 15% of the total number of nerves. times When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments. times A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves. times There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB. times The presence of distinct fascial compartments in the NVB is also confirmed. Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable advances made in this area since the original dissections of Walsh and Donker almost thirty years ago, the precise location and function of these structures remains uncertain. The topic is of tremendous importance as we continue to refine surgical techniques to allow men the maximum opportunity to recover erectile function following radical prostatectomy. Yet many of these surgical refinements are not based on definitive knowledge of the relevant anatomy and clearly more knowledge is required. For the first time, we have not just characterized the quantitative nature of the periprostatic nerves, but we also offer some insight into the likely functional nature of these nerves by selectively staining the sympathetic and parasympathetic nerves using immunohistochemical methods. OBJECTIVE • To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate. MATERIALS AND METHODS • Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred. • The fascial architecture of the neurovascular bundle (NVB) was also quantified. RESULTS • Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o’clock level. At the base, mid, and apex of prostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively. • Sympathetic nerves found above the 3 to 9 o’clock level represented ≈15% of the total number of nerves. • When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments. CONCLUSIONS • A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves. • There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB. • The presence of distinct fascial compartments in the NVB is also confirmed. Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable advances made in this area since the original dissections of Walsh and Donker almost thirty years ago, the precise location and function of these structures remains uncertain. The topic is of tremendous importance as we continue to refine surgical techniques to allow men the maximum opportunity to recover erectile function following radical prostatectomy. Yet many of these surgical refinements are not based on definitive knowledge of the relevant anatomy and clearly more knowledge is required. For the first time, we have not just characterized the quantitative nature of the periprostatic nerves, but we also offer some insight into the likely functional nature of these nerves by selectively staining the sympathetic and parasympathetic nerves using immunohistochemical methods.UNLABELLEDStudy Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable advances made in this area since the original dissections of Walsh and Donker almost thirty years ago, the precise location and function of these structures remains uncertain. The topic is of tremendous importance as we continue to refine surgical techniques to allow men the maximum opportunity to recover erectile function following radical prostatectomy. Yet many of these surgical refinements are not based on definitive knowledge of the relevant anatomy and clearly more knowledge is required. For the first time, we have not just characterized the quantitative nature of the periprostatic nerves, but we also offer some insight into the likely functional nature of these nerves by selectively staining the sympathetic and parasympathetic nerves using immunohistochemical methods.• To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate.OBJECTIVE• To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate.• Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred. • The fascial architecture of the neurovascular bundle (NVB) was also quantified.MATERIALS AND METHODS• Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred. • The fascial architecture of the neurovascular bundle (NVB) was also quantified.• Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o'clock level. At the base, mid, and apex of prostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively. • Sympathetic nerves found above the 3 to 9 o'clock level represented ≈15% of the total number of nerves. • When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments.RESULTS• Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o'clock level. At the base, mid, and apex of prostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively. • Sympathetic nerves found above the 3 to 9 o'clock level represented ≈15% of the total number of nerves. • When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments.• A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves. • There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB. • The presence of distinct fascial compartments in the NVB is also confirmed.CONCLUSIONS• A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves. • There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB. • The presence of distinct fascial compartments in the NVB is also confirmed. Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in particular the fascial layers and neurovascular structures, remain a somewhat enigmatic and controversial area. Despite the considerable advances made in this area since the original dissections of Walsh and Donker almost thirty years ago, the precise location and function of these structures remains uncertain. The topic is of tremendous importance as we continue to refine surgical techniques to allow men the maximum opportunity to recover erectile function following radical prostatectomy. Yet many of these surgical refinements are not based on definitive knowledge of the relevant anatomy and clearly more knowledge is required. For the first time, we have not just characterized the quantitative nature of the periprostatic nerves, but we also offer some insight into the likely functional nature of these nerves by selectively staining the sympathetic and parasympathetic nerves using immunohistochemical methods. • To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate. • Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred. • The fascial architecture of the neurovascular bundle (NVB) was also quantified. • Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o'clock level. At the base, mid, and apex of prostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively. • Sympathetic nerves found above the 3 to 9 o'clock level represented ≈15% of the total number of nerves. • When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments. • A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves. • There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB. • The presence of distinct fascial compartments in the NVB is also confirmed. |
| Author | Costello, Anthony J. Dowdle, Benjamin W. Murphy, Declan G. Pedersen, John Namdarian, Benjamin |
| Author_xml | – sequence: 1 givenname: Anthony J. surname: Costello fullname: Costello, Anthony J. – sequence: 2 givenname: Benjamin W. surname: Dowdle fullname: Dowdle, Benjamin W. – sequence: 3 givenname: Benjamin surname: Namdarian fullname: Namdarian, Benjamin – sequence: 4 givenname: John surname: Pedersen fullname: Pedersen, John – sequence: 5 givenname: Declan G. surname: Murphy fullname: Murphy, Declan G. |
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| Keywords | Immunohistochemistry Nephrology Urinary system disease Prostate disease cavernous nerves Malignant tumor Urology neurovascular bundle nerve-sparing Anatomic pathology Conservative surgery Treatment radical prostatectomy Prostatectomy Cavernous nerve Male genital diseases Prostate cancer Cancer |
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What's known on the subject? and What does the study add?
The anatomy of the periprostatic tissues, in... Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in... Study Type - Therapy (case series)Level of Evidence4 What's known on the subject? and What does the study add? The anatomy of the periprostatic tissues, in... |
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| SubjectTerms | Autonomic Nervous System - metabolism Biological and medical sciences Cadaver cavernous nerves Gynecology. Andrology. Obstetrics Humans Immunohistochemistry Indexing in process Male Male genital diseases Medical sciences Nephrology. Urinary tract diseases Nerve Tissue - metabolism nerve‐sparing neurovascular bundle Penis - innervation Prostate - innervation Prostate - surgery prostate cancer Prostatectomy - methods Prostatic Diseases - metabolism Prostatic Diseases - pathology Prostatic Diseases - surgery radical prostatectomy Tumors Tumors of the urinary system Urinary tract. Prostate gland |
| Title | Immunohistochemical study of the cavernous nerves in the periprostatic region |
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