title: Pelvic autonomic nerve mapping around the prostate by intraoperative electrical stimulation with simultaneous measurement of intracavernous and intraurethral pressure.
abstract: OBJECTIVE
  In previous studies we noted that the neurovascular bundle was not identical to the bundle of the cavernous nerve fibers. In this study we sought to prove these anatomical findings electrophysiologically and map the autonomic nerve fibers by intraoperative simultaneous measurement of intracavernous pressure and intraurethral pressure.
  
  
  METHODS
  Between January 2004 and May 2005 electrical stimulation was performed in 27 open pelvic surgeries, including 26 radical retropubic prostatectomies and 1 radical cystectomy, using an original bipolar electrode before prostate removal. Nerve stimulation was performed at the base of the so-called neurovascular bundle (point A) and the rectal wall about 1 cm posterolateral, apart from the neurovascular bundle (point B). Intracavernous pressure and intraurethral pressure were measured simultaneously.
  
  
  RESULTS
  The mean +/- SD increase in intracavernous pressure was 9.8 +/- 6.3 cm H2O at point A and 13.5 +/- 7.3 cm H2O at point B. Intracavernous pressure at point B was significantly higher than at point A (p = 0.0240). The mean increase in intraurethral pressure was 17.0 +/- 9.4 cm H2O at point A and 11.2 +/- 8.1 cm H2O at point B. Intraurethral pressure at point A was significantly higher than at point B (p = 0.0353).
  
  
  CONCLUSIONS
  The course of the cavernous nerves did not always agree with the surgically identified neurovascular bundle. The distribution of cavernous nerves was wider than our image of the neurovascular bundle and it existed on the rectal wall posterolateral, apart from the neurovascular bundle rather than the neurovascular bundle itself. The surgically identified neurovascular bundle contained the nerve fibers contributing to urinary continence.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York, USA. atake@med.kobe-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tewari
authors.forename: Rouei
authors.initials: R
authors.lastname: Hara
authors.forename: Robert A
authors.initials: RA
authors.lastname: Leung
authors.forename: Kohei
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Gen
authors.initials: G
authors.lastname: Murakami
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000294:innervation*; D001341:Autonomic Nervous System / Q000033:anatomy & histology*; D004558:Electric Stimulation / Q000295:instrumentation; D004594:Electrophysiology; D004867:Equipment Design; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D010413:Penis / Q000294:innervation* / Q000502:physiology*; D011312:Pressure; D011467:Prostate; D014521:Urethra / Q000294:innervation* / Q000502:physiology*