The Periprostatic Autonomic Nerves—Bundle or Layer?

BackgroundThe functional outcome of a nerve-sparing radical prostatectomy (RP) depends on the knowledge of autonomic nerve distribution in correlation to the prostate.ObjectiveRecent literature has focused predominantly on the anterior prostate; this study evaluates the nerve distribution on the entire prostate, using a two-dimensional approach.Design, setting, and participantsFrom 17 non-nerve-sparing (NS) RP specimens, 77 whole mounted serial sections were immunostained with PGP9.5 and analyzed.InterventionEach prostate half was divided into 12 sectors (three levels: apex, mid-part, base; four courses: anterior, anterolateral, posterolateral, posterior).MeasurementsThe extracapsular nerves were counted and classified by size (>200 μm or ≤200 μm).Results and limitationsApproximately two-thirds of the nerves were located in the posterolateral while 26.3/27.0% were located in the anterior and anterolateral. In the anterolateral, along the base–apex direction, the nerves decreased whereas they increased in the posterior. In the anterior, the highest counts were found in the mid-prostate. PGP 9.5 stain helps to determine the extracapsular nerve distribution, however, it does not allow a functional allocation.ConclusionsThe nerve course expands from the base in the mid-part to the anterior sector, before it narrows towards the apex in the posterior lateral and posterior sectors. Therefore, it is recommended that the surgeon focus on nerve preservation in particular at the apex, starting in the anterior at the mid section as well as the common posterolateral course.