The periprostatic autonomic nerves--bundle or layer?
BACKGROUND
The functional outcome of a nerve-sparing radical prostatectomy (RP) depends on the knowledge of autonomic nerve distribution in correlation to the prostate.


OBJECTIVE
Recent literature has focused predominantly on the anterior prostate; this study evaluates the nerve distribution on the entire prostate, using a two-dimensional approach.


METHODS
From 17 non-nerve-sparing (NS) RP specimens, 77 whole mounted serial sections were immunostained with PGP9.5 and analyzed.


METHODS
Each prostate half was divided into 12 sectors (three levels: apex, mid-part, base; four courses: anterior, anterolateral, posterolateral, posterior).


METHODS
The extracapsular nerves were counted and classified by size (>200microm or <or=200microm).


CONCLUSIONS
Approximately two-thirds of the nerves were located in the posterolateral while 26.3/27.0% were located in the anterior and anterolateral. In the anterolateral, along the base-apex direction, the nerves decreased whereas they increased in the posterior. In the anterior, the highest counts were found in the mid-prostate. PGP 9.5 stain helps to determine the extracapsular nerve distribution, however, it does not allow a functional allocation.


CONCLUSIONS
The nerve course expands from the base in the mid-part to the anterior sector, before it narrows towards the apex in the posterior lateral and posterior sectors. Therefore, it is recommended that the surgeon focus on nerve preservation in particular at the apex, starting in the anterior at the mid section as well as the common posterolateral course.
Sievert
Karl-Dietrich
KD
Department of Urology, University of Tuebingen, Tuebingen, Germany. karl.sievert@med.uni-tuebingen.de
Hennenlotter
Jörg
J
Laible
Ines
I
Amend
Bastian
B
Schilling
David
D
Anastasiadis
Aristotelis
A
Kuehs
Ursula
U
Nagele
Udo
U
Stenzl
Arnulf
A
D000368:Aged; D017776:Autonomic Pathways / Q000033:anatomy & histology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000294:innervation* / Q000601:surgery; D011468:Prostatectomy; D012189:Retrospective Studies