Cadaveric Analysis of Periprostatic Nerve Distribution: An Anatomical Basis for High Anterior Release During Radical Prostatectomy?

Clarebrough, Emma; Challacombe, Benjamin; Briggs, Christopher; Namdarian, Benjamin; Weston, Robin; Murphy, Declan; Costello, Anthony J.

doi:10.1016/j.juro.2010.11.046

Cited by 32 publications

(19 citation statements)

References 20 publications

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“…, Clarebrough et al. and Lee et al. counted the extraprostatic nerves by digitisation and computerised planimetry, while Eichelberg et al.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we manually counted the number of nerve fibres per high‐power field as a surrogate of nerve density and found significant correlation with the surgeon's grading of NS. The periprostatic cross‐sectional area has also been used to measure the amount of ECNVT . We measured the cross‐sectional area of ECNVT on the posterolateral aspect of the prostate and found that it correlated best with the amount of NS intended by the surgeon.…”

Section: Discussionmentioning

confidence: 99%

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Proposal of a method to assess and report the extent of residual neurovascular tissue present in radical prostatectomy specimens

et al. 2013

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Objective• To propose a method to assess and report the amount of neurovascular tissue present in radical prostatectomy (RP) specimens. Patients and Methods• The data of 133 consecutive patients who underwent robot-assisted RP by a single surgeon (V.R.P.) were prospectively collected.• Degree of nerve sparing (NS) was graded intraoperatively by the surgeon independently at either side as complete, partial or none. • A pathologist who was 'blinded' to the surgeon's classification measured the following parameters at the posterolateral aspect of the apex, base and mid prostate at either side of the RP specimen: length, width and area of neural tissue, number of nerves per high-power field and number of total slides containing neural tissue. • Measurements were correlated to the surgeon's intraoperative perception. Results• All measurements correlated significantly with surgeon's intent of NS at all locations (P = 0.001).• Among them, the cross-sectional area had the highest correlation coefficient (-0.550 at apex, -0.604 at mid prostate and -0.606 at the base). Conclusions• The cross-sectional area of nerve tissue showed the highest correlation with surgeon's intent of NS at all locations.• Having a standardised method of assessing and reporting residual nerve tissue allows the surgeon to objectively evaluate the quality of nerve preservation and to compare the progress of his NS technique over time.

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“…, Clarebrough et al. and Lee et al. counted the extraprostatic nerves by digitisation and computerised planimetry, while Eichelberg et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Proposal of a method to assess and report the extent of residual neurovascular tissue present in radical prostatectomy specimens

et al. 2013

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“…At the apex, 60% of the nerves were located posterolaterally and 40% were located anterolaterally [32]. In another study, Clarebrough et al [33] showed that the overall proportion of the nerve surface increased at the anterolateral side of the prostate, from 6% at the base to 7.6% at the mid part and to 11.2% at the apex; especially at the apex nerve fibres were more predominant along the anterolateral side of the prostate. Walz et al [34] evaluated these studies as having conflicting results which can be explained by the “interindividual variability” of the anatomy and also by the difference in methodology of the nerve surface and the number of nerve fibers.…”

Section: Fascial Anatomy Of Prostatementioning

confidence: 99%

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

2016

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Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes.

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“…Additionally, they stressed the variability of periprostatic nerve distribution [45]. Clarebrough et al [46] reported a similar periprostatic nerve distribution pattern that showed that the most periprostatic neural tissue was located in the posterolateral region with a smaller proportion on the anterior surface of the prostate.…”

Section: History Of Nsrp and Technical Advances In Fascial Surgerymentioning

confidence: 99%

Novel anatomical identification of nerve-sparing radical prostatectomy: fascial-sparing radical prostatectomy

Hurі

2014

Prostate International

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Radical prostatectomy (RP) became a first choice of treatment for prostate cancer after the advance in nerve-sparing techniques. However, the difficult technical details still involved in nerve-sparing RP (nsRP) can invite unwanted complications. Therefore, learning to recognize key anatomical features of the prostate and its surrounding structures is crucial to further improve RP efficacy. Although the anatomical relation between the pelvic nerves and pelvic fascias is still under investigation, this paper characterizes the periprostatic fascias in order to define a novel fascial-sparing approach to RP (fsRP), which will help spare neurovascular bundles. In uroanatomic perspective, it can be stated that nsRP is a functional identification of the surgical technique while fsRP is an anatomic identification as well. The functional and oncological outcomes related to this novel fsRP are also reviewed.

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Cadaveric Analysis of Periprostatic Nerve Distribution: An Anatomical Basis for High Anterior Release During Radical Prostatectomy?

Cited by 32 publications

References 20 publications

Proposal of a method to assess and report the extent of residual neurovascular tissue present in radical prostatectomy specimens

Proposal of a method to assess and report the extent of residual neurovascular tissue present in radical prostatectomy specimens

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

Novel anatomical identification of nerve-sparing radical prostatectomy: fascial-sparing radical prostatectomy

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