TREPEL NEUROANATOMIE PDF

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Therefore, the key step during the classic NS-RRP is the incision of the lateral pelvic fascia just above the NVB and the lateral displacement of it within the correct plane. Some more-recent reports indicate that the NVB might be more spread around the capsule. As a result, some authors advocate a modification of the standard nerve-sparing technique [3—6].

However to our knowledge there is no detailed description of the exact nerve anatomy in the literature to date, particularly regarding the ventral aspect of the prostate. Therefore, it is the intention of this report to determine the typical pattern of nerve distribution along the complete prostatic capsule. Materials and methods We investigated the permanent sections of 31 patients, who underwent non-nerve-sparing RRP at our institution.

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Speci- mens were processed by the 3-mm step section technique according to the Stanford protocol. Whole-mount histologic Fig. Each slide was taken from the apex, the mid- part and the base of the prostate for the left- and right-hand No significant difference was seen between the side, respectively. As expected, the vast majority permanent marker; Germany. In these two sectors, a The focus of interest lay on the outside of the prostatic median sum of For statistical analyses, the data of counted prostatic specimens, respectively.

Only 3. In addition, the median However, a significant amount of nerves was number of nerves for each of the six sectors at each of the three found above the horizontal line marked by the 3 locations was determined.

The sum of the median percentage found in a certain sector was defined as the median number of of nerves detected in sectors 1—3 were Results 4.

Discussion The median number of spotted nerves per prostatic Radical prostatectomy marks the standard therapy half was The median and maximum numbers of localized prostate carcinoma for patients with of nerves per each sector for both prostatic halves a life expectancy greater than 10 yr, who accept are summarised in Table 1.

The median of nerves treatment-related complications [7].

Since Walsh et al. Generally, parasympathetic fibres from S2—S4 However, with increasing research on the topic, it activate the vasodilatation of the corpora cavernosa is becoming more obvious that the erectile function via the pelvic splanchnic nerves, whereas sympa- is not simply induced by a single bilateral nerve thetic fibres derived from Th12 to L2 within the Fig.

They also noted that the neuronal compo- mical contraction of the ductus deferentes, the nents of the NVB are extensively spread by up to seminal vesicles, and the prostate [12].

It is widely 3 cm anterior—posterior , particularly at the pro- accepted that the CNs, which generate the erection static apex and base. On the basis of these findings, in the cavernosal corpora, derive from the pelvic they see an explanation as to why a single sural plexus, in which both above-mentioned vegetative nerve graft would not always guarantee an adequate strands submerge.

Furthermore, the CNs are sup- interposition to prevent an erectile dysfunction after posed to run on the rectolateral aspect in a fascial non-NS-RRP.

However, divergences in literature already start Besides eight adult male specimens, they investi- with respect to the formation of the various gated 29 male foetal specimens in different components within the NVB: Takenaka et al. The authors found that, a considerably more spray-like manner and at a far with the proceeding of the prostatic expansion more distant region than originally described.

In during its development, the formerly lateral and their study they performed fresh cadaver dissec- dorsal position of the CN increasingly dispersed tions of seven male pelvises and found that the anteriorly along the convex surface of the capsule. Their somewhat surprising conclusion development of benign prostatic hyperplasia in was that CNs cannot be included in a surgical the investigated adult specimens.

The authors reconstructed NVB, and appear to be spread and therefore suggested a modified technique of nerve located beyond the NVB.

In perspective, Tewari et al. In a careful study, Costello et al. This hypothesis prostatic capsule, supplies the NVB. However, even compartments within the NVB. These compart- at the apex close to the distal passage of the NVB ments are supposed to innervate the levator ani alongside the membranous urethra, the percentage muscle, the rectum, or, in case of the most anterior of nerves found on the anterior prostatic half compartment, the corpora cavernosa and the remained relatively high at Since we can neither rates.

Radical prostatectomy nique. The central modification is to start the with preservation of sexual function: anatomical and incision of the parapelvic fascia high up e.

Prostate ;— J Urol ; Certainly one limitation of this study is that we — Anatomical studies of the ment of potency rates attributable to this modifica- neurovascular bundle and cavernosal nerves. BJU Int tion. However, in our latest analyzed bilateral NS- ;—6.

BJU Int ; It certainly would be of clinical importance if the — Open retropubic nerve- also resulted in functional improvements. In a sparing radical prostatectomy. Eur Urol ;— Improving the preservation of the urethral sphincter and neurovascular that incision of the levator fascia should start high bundles during open radical retropubic prostatectomy.

EAU guidelines on prostate excellent results regarding the postoperative erec- cancer. Nerve grafts are rarely necessary and are to this modification. The establishment of the high unlikely to improve sexual function in men under- incision affected the margin rate in neither their going anatomic radical prostatectomy.

Urology ; study nor ours; we identified a positive margin rate —4. Bilateral nerve grafting during radical retropubic and time period. Urology ; —7. Patient-reported sexual function after nerve- 5. Conclusions sparing radical retropubic prostatectomy. Risk factors for all counted nerves neighbouring the prostatic urinary incontinence after radical prostatectomy.

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Noname added it Apr 16, Other trepel neuroanatomie supported by Libsndfile are trepel neuroanatomie web site decodable. Prediction of postoperative sexual function impact of nerve content in the removed specimen.

1. Introduction

In these two sectors, a median of This leads to a mean inter- was performed. Related Papers.

Brain ; 2 — Every single nerve and ganglion in the prostatic capsule and the periprostatic tissue was counted in each sector. The protocol complied with The motor paradigm included three experimental conditions, the declaration of Helsinki and was approved by the Human Re- arranged in a block design.

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