title: Anatomical radical retropubic prostatectomy: 'curtain dissection' of the neurovascular bundle.
abstract: OBJECTIVE
  To investigate the topographical relationship of the cavernosal nerves (CNs) to seminal vesicles, prostate, rhabdosphincter and urethra during the development of the prostate, and to use the resulting morphological data to modify the surgical technique of nerve-sparing radical prostatectomy.
  
  
  METHODS
  The study included 29 male fetuses (gestational age 9-37 weeks) and eight adult specimens assessed anatomically and histologically. Using the plastination technique and anatomical dissection, the course of the CNs was investigated in all specimens. Based on these morphological results, the technique of dissecting the CNs during nerve-sparing radical retropubic prostatectomy was modified.
  
  
  RESULTS
  During early fetal development the fibres of the CNs enclose the prostatic and membranous urethra dorsally and laterally. During the growth of the prostate, the CNs running along the prostate become displaced further anteriorly and spread, thus forming a concave shape (like a 'curtain') of the neurovascular bundles (NVB). Therefore, dissection of the NVB has to start anteriorly to preserve all the nerve fibres that are spread along the surface of the lateral lobes of the prostate.
  
  
  CONCLUSIONS
  From these anatomical findings we propose a modified 'curtain dissection' to improve preservation of the CNs running in the NVB, in which the incision of the periprostatic fascia and dissection of the NVB is far more anterior than previously described.
authors.affiliation: Department of Urology, Medical University, Innsbruck, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lunacek
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Helga
authors.initials: H
authors.lastname: Fritsch
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Hannes
authors.initials: H
authors.lastname: Strasser
mesh_terms: D000368:Aged; D002490:Central Nervous System / Q000196:embryology*; D006801:Humans; D007001:Hypogastric Plexus / Q000473:pathology; D008297:Male; D009412:Nerve Fibers; D010413:Penis / Q000294:innervation*; D011467:Prostate / Q000294:innervation / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000196:embryology / Q000473:pathology / Q000601:surgery*