Topographical anatomy of periprostatic and capsular nerves: quantification and computerised planimetry

Area of Science:

• Urology
• Anatomy
• Surgical Pathology

Background:

• The precise distribution of periprostatic autonomic nerves remains a subject of ongoing research and debate.
• Understanding this anatomy is crucial for nerve-sparing surgical techniques.

Purpose of the Study:

• To investigate the topographical anatomy of autonomic nerves within the periprostatic tissue and prostate capsule (CAP).
• To map the distribution and surface area of these nerves in different prostate regions.

Main Methods:

• Whole-mount prostate sections from 30 radical prostatectomy specimens were analyzed using immunohistochemical nerve staining.
• Sections were evaluated from the base, middle, and apex, divided into 12 sectors and grouped into ventral, ventrolateral, dorsolateral, and dorsal regions.
• Computerized planimetry quantified the total periprostatic nerve surface area in each region.

Main Results:

• A significant decrease in total periprostatic nerve surface area was observed from the base (241.79 mm²) to the apex (89.50 mm²).
• The dorsolateral region showed the highest percentage of nerve surface area (74.5–84.1%), with significant contributions from ventrolateral and dorsal positions.
• The ratio of periprostatic nerves to capsular nerves decreased from base (3.6) to apex (1.9).

Conclusions:

• Periprostatic nerve distribution is variable, with a notable concentration in ventrolateral and dorsal aspects.
• Total nerve surface area diminishes towards the prostate apex as nerves branch into the gland.
• Nerve planimetry is essential for accurately assessing periprostatic nerve distribution, surpassing simple nerve quantification.