Autonomic innervation of the prostate is provided by the cavernous nerves, which follow the course of the capsular arteries. Afferent nerves travel through the prostate to the pelvic plexuses with further transmission directed to thoracolumbar and pelvic spinal segments. The prostatic plexus consists of multiple ganglia found at the prostate and bladder base.
The careful identification and mapping of the neurovascular bundles has provided a major advance in reducing the morbidity of radical prostatectomy.11 With the preservation of the nerve bundles according to appropriate anatomic guidelines, cancer control may be maintained without unnecessarily compromising erectile function.12'13 The relationship of the nerve bundles to the rectum has been described as fixed, while the size of the prostate can have a significant impact on the relative position of the nerves to the gland (lateral versus posteriolateral).
Branches extend from the nerves to the capsule and are in association with the capsular vessels. This arrangement may provide the egress for perineural spread of tumor and is a consideration in higher volume disease.14'15 As a general practical matter, these branches can tether the neurovascular bundle to the prostate surface and should be individually addressed when prominent.16 The neural investment of the urethra will be discussed in the description of continence mechanisms.
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