OBJECTIVETo investigate the precise locations of the blood vessels and nerves surrounding the seminal vesicles (SV) in men and provide some anatomical evidence for SV-related minimally invasive surgery.

METHODSWe observed the courses and distribution of the blood vessels and nerves surrounding SVs and obtained the data for positioning the SV neuroplexes in 20 male pelvises.

RESULTSOne branch of the neuroplexes was distributed to the SVs bilaterally with the neurovascular bundles, (2.85 ± 0.18) cm from the median sulcus of the prostate (MSP), while another branch ran through the Denonvillier fascia behind the SV, (0.81 ± 0.06) cm from the MSP. The arterial SVs (ASV) originated from the inferior vesical artery and fell into 4 types, 55% going directly to the SVs as one branch, 15% running between the SV and the ampulla of the deferent duct as another branch, 25% downward as 2 branches to the SV and between the SV and the ampulla of the deferent duct respectively, and 5% as the other ASVs. The shortest distance from the ASV through the prostatic neuroplexus to the posterior SV was (1.08 ± 0.09) cm.

CONCLUSIONIn SV resection, neuroplexus injury can be reduced with a bilateral distance of < 2.85 cm and a posterior distance of < 0.81 cm from the MSP, and so can bleeding by vascular ligation between the SV and the ampulla of the deferent duct.

Biopsy ; Humans ; Male ; Prostate ; blood supply ; innervation ; Seminal Vesicles ; blood supply ; innervation ; Vas Deferens ; blood supply ; innervation

In the western world, adenocarcinoma of the prostate is the most common malignant neoplasm of human males. In recent years, the incidence of the disease has increased dramatically in China. Surgery is an important treatment for prostate cancer. This article reviews the progress in radical retropubic and perineal prostatectomy, standard laparoscopic and robot-assisted laparoscopic radical prostatectomy. It covers the necessity, techniques and experience of surgery, nerve preserving techniques and erectile dysfunction, complications and outcomes, advantages and disadvantages of and comparison between various surgical approaches.
Humans ; Laparoscopy ; Male ; Prostate ; innervation ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Robotics

Trauma and surgery sometimes cause erectile dysfunction because of injury to pelvic nerves and cavernous nerves of the penis. The ideal treatment is to make the injured nerves regenerate themselves and erectile function recover completely. This paper reviews the recent advances in the studies of erigentes regeneration and plerosis following injury in order to find the best method to enhance erigentes regeneration.
Erectile Dysfunction ; therapy ; Humans ; Male ; Penile Erection ; physiology ; Penis ; innervation ; Peripheral Nerve Injuries ; Regeneration ; Transurethral Resection of Prostate ; adverse effects

We investigated the distribution and navigation of periprostatic nerve fibers and constructed a 3-dimensional model of nerve distribution. A total of 5 cadaver specimens were serially sectioned in a transverse direction with 0.5 cm intervals. Hematoxylineosin staining and immunohistochemical staining were then performed on whole-mount sections. Three representative slides from the base, mid-part, and apex of each prostate were subsequently divided into 4 sectors: two lateral, one ventral, and one dorsal (rectal) part. The number of nerve fibers, the distance from nerve fiber to prostate capsule, and the nerve fiber diameters were analyzed on each sector from the representative slides by microscopy. Periprostatic nerve fibers revealed a relatively even distribution in both lateral and dorsal parts of the prostate. There was no difference in the distances from the prostate capsule to nerve fibers. Nerve fibers in the ventral area were also thinner as compared to other areas. In conclusion, periprostatic nerve fibers were observed to be distributed evenly in the periprostatic area, with the exception of the ventral area. As the number of nerve fibers on the ventral part is fewer in comparison, an excessive high up incision is insignificant during the nerve-sparing radical prostatectomy.
Adult ; Aged ; *Cadaver ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; *Models, Anatomic ; Neuroanatomy ; Peripheral Nerves/*anatomy & histology ; Prostate/*innervation ; Prostatectomy/methods ; Prostatic Neoplasms/surgery

OBJECTIVETo explore the impacts of denervation on the morphology and the expression of neuronal nitric oxide synthase (nNOS) of prostate of the adolescent rats.

METHODSAdolescent male SD rats were randomly divided into group A and group B. The right pelvic ganglion denervation was performed in group B with the help of surgical microscope, and group A received a sham operation. Five weeks later, the ventral prostates were obtained for morphologic observation, apoptosis detection and the evaluation of nNOS expression.

RESULTSA 30.8% reduction of right ventral prostate (RVP) fresh weight was found in group B. After denervation, histological features showed an overall decrease in the numbers of cells and cell height, and apoptosis indexes (AI) was significantly higher than that in group A (P <0.01), while the expression of nNOS decreased apparently (P < 0.01).

CONCLUSIONThe study indicates that denervation can cause apoptosis of the prostatic, and affect the prostate growth of the adolescent rat. During this process, nNOS plays an important role in the regulation of apoptosis.

Animals ; Apoptosis ; Denervation ; In Situ Nick-End Labeling ; Male ; Nitric Oxide Synthase Type I ; biosynthesis ; Prostate ; cytology ; innervation ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Sexual Maturation

The neurovascular bundle of the prostate and cavernosal nerves have been used to describe the same structure ever since the publication of the first studies on the neuroanatomy of the lower urogenital tract of men, studies that were prompted by postoperative complications arising from radical prostatectomy. In urological surgery every effort is made to preserve or restore the neurovascular bundle of the prostate to avoid erectile dysfunction (ED). However, the postoperative potency rates are yet to be satisfactory despite all advancements in radical prostatectomy technique. As the technology associated with urological surgery develops and topographical studies on neuroanatomy are cultivated, new observations seriously challenge the classical teachings on the topography of the neurovascular bundle of the prostate and the cavernosal nerves. The present review revisits the classical and most recent data on the topographical anatomy of the neurovascular bundle of the prostate and cavernosal nerves and their implications on radical prostatectomy techniques.
Erectile Dysfunction ; prevention & control ; Humans ; Hypogastric Plexus ; anatomy & histology ; Male ; Postoperative Complications ; prevention & control ; Prostate ; innervation ; surgery ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery

OBJECTIVETo explore acupuncture-assisted anesthesia in transrectal ultrasound guided prostate biopsy via the perineum.

METHODSOne hundred and five cases of prostate biopsy were randomly divided into two groups. For 51 cases in observation group (group A), the periprostatic nerve plexus block and acupuncture on bilateral Zusanli (ST 36) were applied. For 54 cases in control group (group B), the simple periprostatic nerve plexus block was adopted. Visual Analogue Score (VAS) was used to evaluate the pain extent after biopsy and blood pressure and heart rate were monitored before, during and after operation, separately.

RESULTSVAS scores were 0.9 +/- 0.8 and 2.8 +/- 1.0 in group A and group B, separately, indicating statistical significant difference in comparison (P < 0.01). Additionally, in group B, blood pressure and heart rate during and after operation were higher remarkably than those before operation (all P < 0.05). Moreover, in group B, blood pressure during operation and heart rate during and after operation were all higher apparently than those in group A (all P < 0.05).

CONCLUSIONAcupuncture-assisted anesthesia alleviates apparently pain and discomforts during transrectal ultrasound guided prostate biopsy via the perineum in patients and ensures the stability of blood pressure and heart rate.

Acupuncture Analgesia ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Humans ; Male ; Middle Aged ; Pain Management ; Perineum ; innervation ; Prostate ; pathology ; Prostatic Diseases ; diagnosis ; pathology

OBJECTIVETo study the pathological change of rats' benign hyperplastic prostate (BHP) after radical denervation.

METHODSA total of 65 male spontaneous hypertension rats (SHR) at 30 weeks age were randomly assigned into treatment group, sham surgery control group and normal control group. In surgery group, all the axonal branches of the major pelvic ganglion (MPG) supplying the bilateral prostate were truncated, followed performing of cystostomy; In sham surgery control group, only cystostomy was performed; In normal control group, no procedure was performed. The rats were sacrificed at 3, 7, 11, 15 and >or= 21 d post-operation respectively. The gross morphological changes of prostate in all animals were observed.

RESULTSIn treatment group, the prostate in 3 d post-operation showed granular solidification and shrunken volume and the changes occurred gradually over time. The glandular epithelial cells showed gradual degeneration, necrosis and detachment. The glandular epithelium became progressively thinner, the smooth muscles elongated and thinned progressively and the stromal components showed mild to moderate overgrowth. At the later stage, the glandular epithelium, glandular lumen and smooth muscles gradually disappeared and the prostate was largely replaced by connective tissues. Electron microscopic study showed that the glandular cells gradually underwent vacuolar degeneration and the structures of basement membrane became fuzzy. The smooth muscles cells degenerated overtime and the fibroblasts and collagenous fibers in the stroma overgrew slowly. At the late stage, most of the glandular cells became necrotic, the basal membrane and smooth muscle cells disappeared and collagenous fibers were highly hyperplasic. In surgery group in 3 d post-operation, the S-100 staining of nerve fiber was diffuse and disappeared after 11 d while it persisted normally in other groups. The two values in sham surgery control group showed no significant changes post-operatively.

CONCLUSIONSAfter radical denervation, the rat prostate with benign hyperplasia (gland and smooth muscles) undergoes dramatic atrophic changes and the volume decreases significantly. It suggests that this treatment may represent a novel therapy for BPH.

Animals ; Denervation ; methods ; Disease Models, Animal ; Male ; Microscopy, Electron, Transmission ; Prostate ; innervation ; pathology ; ultrastructure ; Prostatic Hyperplasia ; pathology ; surgery ; Random Allocation ; Rats ; Rats, Inbred SHR

OBJECTIVETo establishment and verify pelvic nerve denervation (PND) model in mice.

METHODS(1) Establishment of models. Seventy-two healthy male SPE class C57 mice with age of 7 weeks and body weight of (25±1) g were chosen. These 72 mice were randomly divided into PND group containing 36 mice and sham operation group containing 36 mice. Referring to the establishment method of PND rats, after anesthesia, a laparotomy was performed on the mouse with an abdominal median incision. Under the dissection microscope, the pelvic nerves behind and after each sides of the prostate gland were bluntly separated with cotton swabs and cut with a dissecting scissor. After the operation, the urination of mice was assisted twice every day. For the mice of sham operation group, the pelvic nerves were only exposed without cutting. (2) Detection of models. Colonic transit test was performed in 18 mice chosen randomly from each group to detect the colonic transit ratio (colored colon by methylene blue/ whole colon) and visceral sensitivity tests was performed in the rest mice to observe and record the changes of electromyogram.

RESULTSThree mice died of colonic transit test in each group. Uroschesis occurred in all the mice of PND group and needed bladder massage to assist the urination. Colonic transit test showed that the colonic transit ratios of sham operation group at postoperative day (POD) 1, 3 and 7 were (0.4950±0.3858)%, (0.6386±0.1293)% and (0.6470±0.1088)% without significant difference (F=0.3647, P=0.058), while in PND group, the colonic transit ratio at POD 7 [(0.6044±0.1768) %] was obviously higher than that both at POD 3[(0.3876±0.1364)%, P=0.022] and POD 1[(0.2542±0.0371)%, P=0.001], indicating a recovery trend of colonic transit function (F=9.143, P=0.004). Compared with the sham operation group, the colonic transit function in PND group decreased significantly at POD 1 and POD 3(both P<0.05), and at POD 7, there was no significant difference between two groups. Visceral sensitivity test showed that the visceral sensitivity of sham operation group at POD 1, 3 and 7 was 24.2808±9.5566, 33.6725±7.9548 and 43.9086±12.1875 with significant difference (F=5.722, P=0.014). The visceral sensitivity of PND group at POD 1, 3 and 7 was 11.7609±2.1049, 21.8415±8.1527 and 26.2310±4.2235 with significant difference as well (F=11.154, P=0.001). The visceral sensitivity at POD 3 and POD 7 was obviously higher than that at POD 1 (P=0.006, P<0.001), and there was no significant difference between POD 3 and POD 7 (P=0.183). Compared with sham operation group, the visceral sensitivity of PND group decreased significantly at POD 1, 3 and 7(all P<0.05).

CONCLUSIONSDenervation of pelvic nerves can obviously decrease the colonic transit function and the visceral sensitivity of mice, but these changes can recover over time, which suggests that the establishment of PND model in mice is successful.

Abdominal Pain ; physiopathology ; Animals ; Autonomic Pathways ; growth & development ; physiopathology ; surgery ; Colon ; innervation ; physiopathology ; Denervation ; methods ; Disease Models, Animal ; Gastrointestinal Transit ; physiology ; Male ; Mice ; Mice, Inbred C57BL ; Nerve Tissue ; growth & development ; physiopathology ; surgery ; Pain, Postoperative ; physiopathology ; Pelvis ; innervation ; physiopathology ; surgery ; Prostate ; innervation ; Recovery of Function ; physiology