title: Anatomical study of pelvic nerves in relation to seminal vesicles, prostate and urethral sphincter: immunohistochemical staining, computerized planimetry and 3-dimensional reconstruction.
abstract: OBJECTIVE
  Studies of male pelvic neuroanatomy are mandatory to improve functional outcome after radical prostatectomy. We performed a topographical investigation of nerves on the course from the seminal vesicles along the prostate toward the striated urethral sphincter.
  
  
  METHODS
  Serial whole mount sections (1 mm intervals) of pelvic blocks of human adult male autopsy cadavers were investigated after immunohistochemical nerve staining. Computerized nerve quantification and planimetry of the total nerve surface area were performed within defined regions (ventral, ventrolateral, dorsolateral and dorsal) at the levels of the seminal vesicles and prostate, and at the striated urethral sphincter. The distance between the seminal vesicles and the nerves was measured. For improved topographical understanding 3-dimensional reconstructions were created. Differences between 3 independent variables were tested with the nonparametric Kruskal-Wallis test.
  
  
  RESULTS
  We studied a total of 969 whole mount sections of 5 cadavers. Nerves were arranged in a vertical plate lateral to the seminal vesicles. Mean ± SD distance to the seminal vesicles was 1.68 ± 0.84, 1.50 ± 0.12 and 1.76 ± 0.37 mm at the tip, middle and base, respectively. Periprostatic nerves were mainly found dorsolaterally. At the striated urethral sphincter 38.9% of nerves had shifted to the dorsal region. The total nerve surface area decreased significantly from the seminal vesicle tip (50.2 mm(2)) to the striated urethral sphincter level (13.3 mm(2)) (p = 0.0004).
  
  
  CONCLUSIONS
  Our findings underline that during nerve sparing prostatectomy nerve damage might occur during mobilization of the entire seminal vesicles, apical dissection and posterior reconstruction of the rhabdosphincter. Nerve planimetry revealed that 75% of the nerves from the seminal vesicles do not reach the striated urethral sphincter level and seem to innervate structures other than the corpora cavernosa.
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany. Electronic address: roman.ganzer@medizin.uni-leipzig.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Ganzer
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Neuhaus
authors.affiliation: Department of Pathology, University of Regensburg, Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Weber
authors.affiliation: Institute of Human Anatomy and Embryology, University of Regensburg, Regensburg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Fuchshofer
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bründl
mesh_terms: D002102:Cadaver; D006801:Humans; D021621:Imaging, Three-Dimensional; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000294:innervation*; D011467:Prostate / Q000294:innervation*; D012669:Seminal Vesicles / Q000294:innervation*; D013194:Staining and Labeling; D014521:Urethra / Q000294:innervation*
keywords: neuroanatomy; prostate; prostatectomy; seminal vesicles; urethra