title: Surgical anatomy of the prostate in the era of radical robotic prostatectomy.
abstract: OBJECTIVE
  New insights in the anatomy of the prostate and the surrounding tissue evolve the technique of radical prostatectomy for the treatment of prostate cancer.
  
  
  RESULTS
  Regarding the course of the erectile nerves along the prostate, recent studies confirmed the presence of parasympathetic pro-erectile nerve fibers at the anterolateral aspect of the prostate. Another study of intraoperative electrostimulation of those nerves confirmed an increase in intracavernosal pressure by stimulations between the 1 and 3 o'clock position. Therefore, it is very likely that these anterior nerve fibers have an effect on erectile function. Regarding the urethral sphincter in the male, a study showed no attachment of the external sphincter to the levator ani muscle, probably resulting in an absence of a levator ani support to the continence mechanism. The male urinary sphincter seems to be in isolation responsible for urinary continence.
  
  
  CONCLUSIONS
  The nerve fibers at the anterolateral aspect of the prostate seem to participate in erectile function, which renders the concept of a high anterior release during nerve sparing beneficial. The isolated urinary sphincter mechanism results in the need to conserve as much urethral length as possible during radical prostatectomy to avoid urinary incontinence.
authors.affiliation: Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France. walzj@marseille.fnclcc.fr
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D008297:Male; D010388:Pelvis / Q000033:anatomy & histology; D011467:Prostate / Q000033:anatomy & histology* / Q000294:innervation / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome; D014521:Urethra / Q000033:anatomy & histology; D014549:Urinary Incontinence / Q000517:prevention & control