Nerve Distribution along the Prostatic Capsule

Abstract

ObjectivesRecent literature describes indications for a more-complex course of fibres of the neurovascular bundle (NVB), despite the widely held assumption that it is gathered at the rectolateral side of the prostate. The objective of this study therefore was to determine the typical pattern of nerve distribution along the prostatic capsule. Materials and methodsPermanent sections of 31 patients, who underwent non-nerve-sparing radical prostectomy (RP) at our institution, were investigated.A total of 186 slides taken from the apex, mid-part, and base of the prostate was analyzed by microscopy. Before microscopy, slides were divided into 12 sectors and numbered clockwise starting from “1” for left ventral sides to “6” for the rectal sides (accordingly, “12”–“7” for right half). Every single nerve and ganglion in the prostatic capsule and the periprostatic tissue was counted in each sector. ResultsThe majority of nerves found in the sectors corresponded to the typical location of the NVB at the rectolateral sides of the prostate (4/5 or 8/9 o’clock sectors). In these two sectors, a median of 45.9–65.6% of counted nerves per half was found. However, a significant amount of nerves (21.5%–28.5%) was detected above the horizontal line. ConclusionsWe conclude that 1/5–1/4 of nerves can be found along the ventral circumference of the prostatic capsule. To preserve a maximum number of nerves, we therefore recommend a modification of the surgical technique by focusing on a high incision for nerve sparing on the ventral parts of the prostate.