Prostatic Neurovascular Anatomical Variation May Explain Radical Prostatectomy Outcomes

Abstract

Radical prostatectomy is a common surgical option to excise primary tumors of the prostate. However, one common complication is erectile dysfunction thought to be caused by traction or severing of the cavernous nerves that course near the prostate and have erectile functionality. Specialized surgical approaches, such as laparoscopic robot‐assisted nerve‐sparing techniques, attempt to minimize nerve damage. Yet, the majority of studies show postsurgical potency rates among the prostatectomy approaches are highly variable and 2‐month potency recovery is no better for specialized approaches than traditional ones. We hypothesize that the variability in outcomes may be explained by variability in the course and anatomical relationships of the cavernous nerves. To test this hypothesis, we conducted detailed prostatic dissections using an 8 diopter, 4x LED magnifying lamp in human male cadavers (n=5). For these dissections, the urinary bladder, prostate, and proximal penis were dissected along with accompanying neurovasculature in the lateral prostatic fascia. The neurovascular bundle (NVB) containing the cavernous nerves was isolated and its branches were followed along the prostate. Although our study was limited to five prostatic dissections, we found the course of the NVB and its branches differed in each individual, sometimes being enveloped by prostatic tissue, other times coursing along the prostatic surface with only minor adherence. The results of our preliminary investigation suggest variation in prostatic neurovascular anatomy may help explain variation in radical prostatectomy outcomes observed across multiple surgical approaches.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.