3-dimensional demonstration of the periprostatic nerve bundle after radical prostatectomy

SUMMARYThe aim of this study is to show the 3- dimensional distribution of the nerves on the prostate, after non-nerve sparing robotic radical prostatectomy.Six cases of non-nerve-sparing robotic radical prostatectomy included to this study that of which has operated by a single surgeon (L.Tunç,M.D, University Of Gazi School of Medicine, Ankara, Turkey) between November 2011 - April 2012 in our clinic. Post-operative radical prostatectomy specimens divided into 4mm. transverse slices, each slice projection is drawn on A4 paper. Surgical specimens were stained with Hematoxylin-Eosin. In each case 2 slides have been taken from the apex, the mid-body, and the base of prostate. The number of total nerves on the outside of the prostatic capsule has been determined manually for each zone. These sections have been microscopically examined and neural map was prepared. A computerized 3-dimensional reconstruction was made by using neural maps.In all cases the nerves most commonly seen in the posterolateral side of prostate. Distribution of nerves were seen 19% in anterior, 11,9% in posterior, and 48,2% in posterolateral of prostat, respectively. The nerve numbers in the apex were counted as less than the middle and basis. We observed neurovascular bundle was spread anteriorly, without bundle like formation in cases. The contribution of the parasympatic nerves spread on the anterior aspect of prostate in erection should be remembered.In nerve-sparing surgery, robotic system, intrafascial and interfascial techniques should be used, without compromising oncologic principles. So that there will be more positive results of erectil function.In determining anatomy and physiology of neurovascular bundle, the robotic asisted technique, together with the evaluation of a large number cases, immunuhistochemical and 3-dimensional reconstruction will provide more efficient results.