Whither go pro-erectile nerves of the neurovascular bundles?

In visual reconstructions, as contained in their remarkable figures, Alsaid and coworkers [1] used computer-aided anatomic ‘‘dissection’’ (CAAD) to follow the nerve fibers distally beyond the prostate apex, finding an anterior division destined for the corpora cavernosa and a posterior division entering the corpus spongiosum. Multiple sequential axial sectionswere obtained from the level of the seminal vesicles to the penis. They stained the sectionswith the silver stain for nerves (S-100), and then they used the computer to sum all the sections to reconstruct the course of the nerves three-dimensionally as they proceeded distally. With this method, identification of a split in nerve-fiber direction was possible. The points of termination beyond the apex of the prostate included an anterior group or division associated with the corpora cavernosa and dorsal sensory nerve of the penis and aposterior division entering the superior surface of the bulb of the penis, or corpus spongiosum. From a physiologic standpoint, just exactly how autonomic nerves of each neurovascular bundle (NVB) [2] heading distally interact and coordinate function, beyond the final result of producing an erection when stimulated, is not precisely clear. ‘‘Pro-erectile’’ nerves accompany other autonomic nerves within the NVBs that depart along the way to innervate seminal vesicles, vasa deferentia, bladder, rectum, and membranous urethra [3]. Some nerves at the apex of the prostate are parasympathetic; some are sympathetic [4]. What then becomes more complicated are concepts such as sympathetic nerves that are not adrenergic, as expected, but cholinergic with vasodilatory potential. To further complicate matters anteriorly at and beyond the penile hilum, there are proven visible neural connections with the dorsal sensory nerve of the penis where direct cavernous nerve penetration begins and proceeds distally [5]. The current study [1] confirms, during radical prostatectomy, the concept of anterior fascial and nerve preservation