title: The periprostatic autonomic nerves--bundle or layer?
abstract: 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.
authors.affiliation: Department of Urology, University of Tuebingen, Tuebingen, Germany. karl.sievert@med.uni-tuebingen.de
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
authors.forename: Jörg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Ines
authors.initials: I
authors.lastname: Laible
authors.forename: Bastian
authors.initials: B
authors.lastname: Amend
authors.forename: David
authors.initials: D
authors.lastname: Schilling
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Anastasiadis
authors.forename: Ursula
authors.initials: U
authors.lastname: Kuehs
authors.forename: Udo
authors.initials: U
authors.lastname: Nagele
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
mesh_terms: 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