Volume 59, Issue 6, Pages 902-909 (June 2011) Division of Autonomic Nerves Within the Neurovascular Bundles Distally into Corpora Cavernosa and Corpus Spongiosum Components: Immunohistochemical Confirmation with Three-Dimensional Reconstruction  Bayan Alsaid, Thomas Bessede, Djibril Diallo, David Moszkowicz, Ibrahim Karam, Gérard Benoit, Stéphane Droupy  European Urology  Volume 59, Issue 6, Pages 902-909 (June 2011) DOI: 10.1016/j.eururo.2011.02.031 Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 1 Two serial histologic 5-μm-thick transverse sections of a 17-wk-old male foetus at the base of the prostate, scanned at an optical resolution of 4800 dpi; (A) stained with haematoxylin-eosin; (B) immunolabelled with anti-S100 antibody; and (C) computer-assisted anatomic dissection of all anatomic structure at this level. Fibres from the inferior hypogastric (pelvic) plexus (IHP) and its adjacent vessels are located in a posterolateral triangle between the prostate (P), the levator ani (LA), and the rectum (classical position of the neurovascular bundles). Nerve fibres are found posterior to the prostate, providing innervations to the seminal vesicles (SVs), the vas deferens (VD), and the prostate gland. Some fibres are found in a position anterolateral to the prostate (white arrows in B and C), under the venous plexus and the detrusor apron (DA). European Urology 2011 59, 902-909DOI: (10.1016/j.eururo.2011.02.031) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 2 (A) Computer-assisted anatomic dissection (CAAD) of the seminal vesicles (SVs); (B) histologic transverse sections of a 72-yr-old adult cadaver proximal to the SVs, immunolabelled with anti-S100 antibody and scanned at an optical resolution of 3200 dpi. Nerves fibres surrounded the SVs and the vas deferens (VD) in a “cage-like” distribution. Lateral branches continued posterolaterally. Some of the medial branches accompanied the VD towards the prostate gland. European Urology 2011 59, 902-909DOI: (10.1016/j.eururo.2011.02.031) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 3 (A) Histologic transverse section of 72-yr-old adult cadaver at the level of the prostate apex, immunolabelled with anti-S100 antibody and scanned at an optical resolution of 3200 dpi. On the right, sector division in a clockwise direction (1–6 o’clock); on the left, the corresponding anterior (ant.), anterolateral (ant. lat.), posterolateral (post. lat.), and posterior (post.) regions, classical position of the neurovascular bundle (NVBs) in the posterolateral regions (back arrow), location of fibres in the anterolateral regions (white arrow). (B–Q) Serial histologic transverse sections (4mm apart) between the membranous urethra (U) and corpus spongiosum levels, with some of the anterolateral nerve fibres (B–F, white arrows) travelling towards the penile hilum (PH) and the corpora cavernosa. The posterolateral nerve fibres (G–Q, black arrows) form the distal course of the NVBs and reach the corpus spongiosum (CS). European Urology 2011 59, 902-909DOI: (10.1016/j.eururo.2011.02.031) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 4 Illustrations in transverse section of the periprostatic nerve distribution at the (A) base of the prostate; (B) midprostate; (C) apex of the prostate; and (D) membranous urethra. Nerves fibres are found in the posterolateral (post. lat.) neurovascular bundles (NVBs) and anterolateral (ant. lat.) to the prostate (P) between the prostate fascia (PF) and the visceral endopelvic fascia (VEF). The anterolateral fibres continue towards the corpora cavernosa, forming the cavernous nerves (CNs); the posterolateral fibres reach the corpus spongiosum, forming the corpus spongiosum nerves (CSNs). CS=colliculus seminalis; DA=detrusor apron; EUS=external urethral sphincter; IUS=internal urethral sphincter; LA=levator ani; OM=obturator muscle; P=prostate; PC=prostate capsule; PEF=parietal endopelvic fascia; SV=seminal vesicles; VD=vas deferens; VP=venous plexus of Santorini. European Urology 2011 59, 902-909DOI: (10.1016/j.eururo.2011.02.031) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 5 Three-dimensional computer-assisted anatomic dissection from transverse immunolabelled histologic sections of a 15-wk-old male foetus. (A) Superior view of intrapelvic organs showing supra- and infralevator neurovascular pathways, (B) same view without the levator ani muscle (LA), the pudendal vessels (Pud.) and the venous plexus. The pudendal nerve (PN) provides somatic innervations (black arrows) to the urethral sphincter (US) before generating the dorsal nerve of the penis (DNP). (C, right lateral; D, anterosuperior, and E, left lateral views of the supralevator pathways), the inferior hypogastric plexus (IHP) is located lateral to the rectal wall. Fibres with a posterior trajectory innervate the rectum and the anal canal. From the anterior edge of the plexus, some fibres follow a trajectory posterolateral to the prostate (P), forming, together with the adjacent vessels (accessory pudendal arteries), the neurovascular bundles (NVBs). The corpus spongiosum nerves (CSNs) represent the distal course of the NVBs to the corpus spongiosum (CS). The fibres in anterior and anterolateral positions around the apex of the prostate follow the trajectory of the cavernous nerves (CNs) laterally and anterolaterally to the US, finally reaching the corpora cavernosa (CC). European Urology 2011 59, 902-909DOI: (10.1016/j.eururo.2011.02.031) Copyright © 2011 European Association of Urology Terms and Conditions

Fig. 6 Three-dimensional computer-assisted anatomic dissection from transverse immunolabelled histologic sections of a cadaver of a 74-yr-old man. (A) Superior view of intrapelvic organs showing supralevator and the distal part of infralevator neurovascular pathways; (B) same view without the pelvic diaphragm (PD), the pudendal vessels (Pud.), and the venous plexus (VP). The pudendal nerve (PN) innervates the urethral sphincter (US) before becoming the dorsal nerve of the penis (DNP). Branches from the PN intermingle with the cavernous nerves, forming a caverno-pudendal distal communication (black arrows). The neurovascular bundles (NVBs) are located in their classical position, posterolateral to the base of the prostate (P). Nerve fibres are also found in anterior and anterolateral (ant. lat.) positions, following the lateral edges of a triangle (black triangle) with its tip at the apex of the prostate. (C) Right anterolateral and (D) left anterolateral views of the supralevator nerve pathways. The NVBs contain two divisions: the cavernous nerves (CNs), forming a continuation of the anterolateral fibres extending towards the corpora cavernosa (CC) and the penile hilum, and the corpus spongiosum nerves (CSNs), which represent the distal course of the posterolateral (post. lat.) NVBs reaching the corpus spongiosum bulb (CS). European Urology 2011 59, 902-909DOI: (10.1016/j.eururo.2011.02.031) Copyright © 2011 European Association of Urology Terms and Conditions