title: Cadaveric analysis of periprostatic nerve distribution: an anatomical basis for high anterior release during radical prostatectomy?
abstract: OBJECTIVE
  An accurate, complete understanding of the prostate neuroanatomy is required to optimize nerve sparing techniques during radical prostatectomy. However, the precise topography and function of the periprostatic nerves remain contentious and there is uncertainty about which nerve sparing technique is most optimal. We accurately quantified the distribution, precise localization and cross-sectional area of periprostatic neural tissue using cadaveric specimens.
  
  
  METHODS
  We analyzed 13 cadaveric hemipelves using hematoxylin and eosin stained sections from the base, mid zone and apex of each prostate. Each section was digitized and divided into 6 sectors numbered clockwise. Analysis was performed using National Institutes of Health ImageJ software to calculate the total periprostatic neural cross-sectional area per sector.
  
  
  RESULTS
  Calculating the total neural cross-sectional area highlighted a decrease from prostate base to mid zone to apex of 24.7, 19.7 and 13.7 mm(2), respectively. Most neural tissue was located in the posterolateral region. However, the proportion surrounding the anterior part of the prostate increased toward the apex with a median of 6.0% and 7.6% at the base and mid zone regions, respectively, increasing to 11.2% at the apex.
  
  
  CONCLUSIONS
  Simple numerical nerve quantification may be insufficient to accurately describe the periprostatic neural distribution. Calculating nerve bundle cross-sectional area confirmed that most neural tissue is in the posterolateral region, although the proportion located anterior increases from base to apex. Thus, higher release of the periprostatic fascia may be indicated toward the apex.
authors.affiliation: Department of Anatomy and Cell Biology, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Emma E
authors.initials: EE
authors.lastname: Clarebrough
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Challacombe
authors.forename: Christopher
authors.initials: C
authors.lastname: Briggs
authors.forename: Benjamin
authors.initials: B
authors.lastname: Namdarian
authors.forename: Robin
authors.initials: R
authors.lastname: Weston
authors.forename: Declan G
authors.initials: DG
authors.lastname: Murphy
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Costello
mesh_terms: D000368:Aged; D002102:Cadaver; D006801:Humans; D008297:Male; D011467:Prostate / Q000294:innervation*; D011468:Prostatectomy / Q000379:methods*