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Abstract
BackgroundAlthough several distribution patterns of periprostatic neurovascular bundles have been proposed, variant dissection technique based on these patterns still confused surgeons. The aim of this study was to describe the periprostatic neurovascular bundles and their relationship with the fascicles around prostate and provide the accurate morphologic knowledge of periprostatic tissue for prostate operation.MethodsThe pelvic viscera were obtained from 26 adult male cadavers. They were embedded in celloidin and cut into successive slices. The slices were explored with anatomic microscopy. 3-Dimensional reconstruction was achieved with celloidin sections and series software.ResultsThe prostatic capsule which surrounded the dorsal, bilateral aspect of the prostate was attached ventrally to anterior fibrous muscular stroma (AFMS). The lower part of the striated sphincter completely embraced the urethral; the upper part of this muscle covered the lower ventral surface of prostate. The upper ventral surface of prostate is covered by the circular muscle of detrusor. The levator fascia and the capsule adhered on the most convex region of the lateral prostate, but separated on the other region. The pelvic neurovascular bundles (PNVB) divided into the anterior and posterior divisions. The anterior division continued as dorsal vascular complex (DVC). The distal part of DVC entered into penile hilum. The posterior division continued as neurovascular bundles, and then as the cavernous supply (CS). The distal part of CS joined into pudendal neurovascular bundles.ConclusionsThe capsule and AFMS formed a pocket like complex. There were anterior and posterior neurovascular approaches from PNVB to penile hilum.
Highlights
Several distribution patterns of periprostatic neurovascular bundles have been proposed, variant dissection technique based on these patterns still confused surgeons
Neurovascular bundle (NVB) was composed of three supplies: the prostatic supply, the cavernous supply, and the rectal supply (Fig. 1a)
The detrusor apron was located ventral to dorsal vascular complex (DVC)
Summary
Several distribution patterns of periprostatic neurovascular bundles have been proposed, variant dissection technique based on these patterns still confused surgeons. The fascial fascicles around prostate, the distribution pattern of the periprostatic nerves and vessels, and adjacent relationship between them are crucial for determining the dissection technique in prostatectomy. Li et al BMC Urol (2021) 21:6 sandwiched between the prostatic fascia and levator fascia. They proposed intra-, inter- and extrafascial dissection planes [2]. Five nerve-sparing grades have been reported in nerve-sparing prostatectomy based on a land mark artery and fascial structures around prostate, and four nerve-sparing grades have been proposed according to venous system and fascial layers [5, 6]
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