The Distribution Pattern of Periprostatic Neurovascular Bundles Examined with Successive Celloidin Slices

Abstract

Background: Although 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.Methods: The 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.Results: The 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 NVB, and then as the cavernous supply (CS). The distal part of CS joined into pudendal neurovascular bundles. Conclusions: The capsule and AFMS formed a pocket like complex. There were anterior and posterior neurovascular approaches from PNVB to penile hilum.

The progress of dorsal vascular complex control strategy in radical prostatectomy

“…The superficial layer of the DVC is the superficial prostatic vein, which can be divided into four variants: a single superficial vein, a superficial vein with left and right branches, a superficial vein with multiple fine branches and the presence of no superficial veins. 4 The first of these variants is the most common, accounting for approximately 60%. 4 The deep layer of the DVC is the prostatic venous plexus and there is communication between the two at the apex of the prostate.…”

“…Three-dimensional reconstruction of the prostatic apex shows that there is an avascular plane between the junction of the detrusor apron and pubic symphysis and the junction between the prostatic apex and urethra, from which a needle can be inserted from the suture DVC. 4 Previous research described using the fingers to bluntly dissect the space between the urethra and the DVC, possibly entering this plane. [14][15][16] A groove between the prostatic apex and the membranous urethra was identified during laparoscopic RP, which was the lateral aspect of the avascular area.…”

“…4 The first of these variants is the most common, accounting for approximately 60%. 4 The deep layer of the DVC is the prostatic venous plexus and there is communication between the two at the apex of the prostate. 3 The DVC collects venous blood from the dorsal penile vein, internal pudendal vein and obturator vein distally, communicating with the vesico-prostatic venous plexus on both sides.…”