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, 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.

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

“…It is noteworthy that the periprostatic fascia cannot be identified as a single-layer stretching over the lateral surface of the prostate. It contains much more in the majority of cases, both collagenous and adipose tissue elements, and depicts as a multi-layered structure ( 2 , 19 ). The periprostatic fascia may be subdivided into three sections according to the anatomical locations.…”

“…The observed space consisted of loose connective and adipose tissue referred to as areolar tissue ( 24 ). Li et al reported in a small case series of human cadaveric studies that on the most convex region of the lateral prostate, both the lateral periprostatic fascia and the pseudocapsule are highly like to fuse into one structure temporarily ( 19 ). The authors furthermore highlighted the necessity of performing a careful fascia-pseudocapsule separation in order to the minimize damage to surrounding structures ( 19 ).…”

“…Recent human cadaveric studies have demonstrated that the detrusor apron splits into three layers of which some contribute to the PPL ( 35 ). Together with posterior fibers, the detrusor apron complex helps to attach the urinary bladder in the pelvis but does not actively contribute to the urinary continence mechanism ( 1 , 19 , 36 ). The PV/PPLs are paired fibrous bands inserted on the distal third of the posterior surface of the pubic bone and the anterior bladder and stretch to the urethral sphincter ( 25 ).…”

“…Walz et al proposed the term pseudocapsule as an acceptable compromise that accounts for both histological and surgical features (1). Contrary to previous findings indicating that the anterior surface of the prostate was absent of a "capsule, " Li et al could demonstrate that the bilateral ends of the capsule were attached to the anterior fibrous muscular stroma/detrusor apron, forming a pocket-like structure for both prostate and the urethra (19).…”

Modified anterior approach preserving Retzius space versus standard anterior approach robot-assisted radical prostatectomy: A matched-pair analysis

“…The visceral endopelvic fascia, a structure covering the anterior surface of the prostate, fuses with the anterior fibromuscular stroma in the midline to form a pouch-like complex that envelops the prostate and urethra ( 19 , 20 ). The Pubic prostatic ligament complex is also closely associated with urinary control and erectile function ( 21 ). The puboprostatic ligament anchors the bladder, prostate and membranous urethra at the pubic symphysis; The the fascial tendinous arch of pelvis is a fused portion of the mural and visceral components of the intrapelvic fascia that extends from the puboprostatic ligament to the sciatic spine; the puboperinealis muscle is a paired muscle of pubic bone origin located at the prostate-urethral junction and terminating most at the perineal body, which acts as a “hammock “ and supports the urethra posteriorly and is responsible for the cessation of urination ( 22 , 23 ).…”