Applied Anatomy Of The Apex Of The Prostate And Its Significance For Radical Prostatectomy

【Objective】To approach adjacent to the apex of the prostate and distribution of theneurovascular bundle, so as to provide anatomical evidences for nerves sparing radicalprostatectomy.【Methods】The adjacent to the apex of the prostate，distribution of the neurovascularbundles and construction of the dorsalvein complex of penis were observed andstatisted on50sides of the medially dissected pelvis of25male cadavers.【Results】1. In front of rectum, there was an obvious loose connective space between seminalvesicle, basic part of the prostate and Denonvilliers’fascia. Under the basic part, theprostatic fascia and Denonvilliers’fascia were integrated, the space between them wasdisapeared. But there always was a space between the Denonvilliers’fascia and rectalfascia. There were blood vessles, verves and loose connective tissue in it.2. Dorsal vein complex of the penis was deeply undered the puboprostatic ligament. Itcontained not only dorsal venous plexus, but also artery, prostatic nerve plexus,and soon. It closely adjacent to the pubourethralis.3. The neurovascular bundules around the apex of the prostate, which stemed from thepelvic plexus, concentrated mainly on posterolateral and anterolateral the apex of theprostate. They located on1～2,4～5,7～8and10～11o’clock points. The cavernousnerves,which given from the neurovascular bundules, passed through pelvic diaphragmand urogenital diaphragm respectively, inervated cavernous body of the penis andurethra.4. The posterolateral artery together with the corresponding nerve travveled betweenthe Denonvilliers’fascia and posterolateral fascia of the prostate. It given branch toprostate, passed through the space between the pubourethralis and puborectalis and urogenital diaphragm, supplied the cavernous body of the urethra. It was located(6.2±1.3)mm from membrane urethra.【Conclusion】1. During operation of NSRP, seperation after the wall of the prostate can be undertakeninfront of the Denonvilliers fascia uper the basic part of the prostate and behind of theDenonvilliers fascia under the basic part of the prostate.2. Inorder to avoid to damage cavernous nerve of the penis and pubourethralis, cuttingoff the dorsal vein complex can be undertaken in the intrafascia and pubourethralismust be seperated carefully.3. Inorder to avoid to damage anterolateral and posterolateral neurovascular bundle,disection shuld be taken introfascia.4. Damage the branch stemed from the posterolateral vessle which passed through theurogenital diaphragm and supplied the cavernous body of the urethra. Erectiledysfunction may occur..