The origins of the adrenergic fibres which innervate the internal anal sphincter, the rectum, and other tissues of the pelvic region in the guinea-pig

Summary The adrenergic innervation of the pelvic viscera was examined by the fluorescence histochemical technique, applied to tissue from untreated guinea-pigs and from guinea-pigs in which nerve pathways had been interrupted at operation. It was found that adrenergic neurons in the inferior mesenteric ganglia give rise to axons which run in the colonic nerves and end in the myenteric and submucous plexuses and around the arteries of the distal colon. In the rectum, part of the innervation of the myenteric plexus and all of the innervation of the submucous plexus comes from the inferior mesenteric ganglia. The rest of the adrenergic innervation of the myenteric plexus comes from the posterior pelvic ganglia or the sacral sympathetic chains. The innervation of the blood vessels of the rectum is from the posterior pelvic ganglia. Adrenergic nerves run from the sacral sympathetic chains and pass via nerves accompanying the rectal arteries to the internal anal sphincter. Other adrenergic fibres to the internal anal sphincter either arise in, or pass through, the posterior pelvic plexuses. The anal accessory muscle is innervated by adrenergic axons arising in the posterior pelvic plexuses. Adrenergic nerves which run in the pudendal nerves, probably from the sacral sympathetic chains, innervate the erectile tissue of the penis.This work was supported by grants from the Australian Research Grants Committee and the National Health and Medical Research Council. We thank Professor G. Burnstock for his generous support.     

Extrinsic innervation of the pelvic organs in the lesser pelvis of human embryos

Realistic models to understand the developmental appearance of the pelvic nervous system in mammals are scarce. We visualized the development of the inferior hypogastric plexus and its preganglionic connections in human embryos at 4–8 weeks post-fertilization, using Amira 3D reconstruction and Cinema 4D-remodelling software. We defined the embryonic lesser pelvis as the pelvic area caudal to both umbilical arteries and containing the hindgut. Neural crest cells (NCCs) appeared dorsolateral to the median sacral artery near vertebra S1 at ~5 weeks and had extended to vertebra S5 1 day later. Once para-arterial, NCCs either formed sympathetic ganglia or continued to migrate ventrally to the pre-arterial region, where they formed large bilateral inferior hypogastric ganglionic cell clusters (IHGCs). Unlike more cranial pre-aortic plexuses, both IHGCs did not merge because the 'pelvic pouch', a temporary caudal extension of the peritoneal cavity, interposed. Although NCCs in the sacral area started to migrate later, they reached their pre-arterial position simultaneously with the NCCs in the thoracolumbar regions. Accordingly, the superior hypogastric nerve, a caudal extension of the lumbar splanchnic nerves along the superior rectal artery, contacted the IHGCs only 1 day later than the lumbar splanchnic nerves contacted the inferior mesenteric ganglion. The superior hypogastric nerve subsequently splits to become the superior hypogastric plexus. The IHGCs had two additional sources of preganglionic innervation, of which the pelvic splanchnic nerves arrived at ~6.5 weeks and the sacral splanchnic nerves only at ~8 weeks. After all preganglionic connections had formed, separate parts of the inferior hypogastric plexus formed at the bladder neck and distal hindgut.     

Organization of lumbar spinal outflow to distal colon and pelvic organs

The lumbar sympathetic outflow projects through the lumbar splanchnic, lumbar colonic, and hypogastric nerves (and to a lesser degree through the sacral sympathetic chain and pelvic nerves). It is thought to be involved in the regulation of the storage and evacuation functions of the following three organ systems: lower urinary tract, hindgut, and reproductive organs. In addition, it controls vascular resistance and capacitance. Thus the target tissues of the postganglionic neurons are vascular smooth muscle, visceral smooth muscles, probably secretory epithelia, and also neurons in the enteric nervous system and the pelvic ganglia. The preganglionic neurons are situated in the caudal part of the spinal representation, neurons associated with the colon being located rostral to those associated with the pelvic organs. Most lie medial to the classical intermediolateral cell column that may contain mainly vasoconstrictor neurons. Most (if not all) preganglionic neurons are cholinergic; some also contain an identified peptide. Most of the postganglionic neurons are situated in the inferior mesenteric ganglion (or equivalent structures); again, those projecting to the colon lie rostral to those projecting to the pelvic organs. Others lie in intercalated prevertebral ganglia, in the pelvic plexus, and in sacral paravertebral ganglia. The majority is noradrenergic, and most also contain one or several peptides, the topographical distribution of which appears to characterize functional subgroups of neurons. The terminations of noradrenergic axons in many pelvic organs probably make close contact with both vascular and nonvascular effectors. In the colon, most endings are located in the enteric plexuses. The responses of these organs to electrical stimulation of visceral nerves, and their reflex responses (together with those observed in the efferent axons of visceral nerve trunks) to electrical and natural stimulation of afferent fibers, lead to the general conclusion that several distinct classes of pre- and postganglionic neurons exist. 1) Vasoconstrictor neurons demonstrate ongoing activity with cardiac rhythm and appropriate reflexes to stimulation of cardiovascular afferent receptors and respond only weakly to natural stimulation of visceral receptors. 2) MR neurons respond to visceral stimuli but are not influenced from arterial baro- and chemoreceptors. These show at least two different response patterns consistent with their separate involvement in the reciprocal behavior of the colon and bladder. 3) Other neurons are silent in anesthetized animals and do not respond to any stimuli used thus far.(ABSTRACT TRUNCATED AT 400 WORDS)     

Locations and innervation of cell bodies of sympathetic neurons projecting to the gastrointestinal tract in the rat

The locations of cell bodies of sympathetic neurons projecting to the stomach, the duodenum, the ileum, the colon, the spleen and the pancreas have been studied using retrograde tracing. Projections arose from both pre- and paravertebral ganglia. In the rat, the prevertebral ganglia are the paired coeliac ganglia lying caudo-lateral to the root of the coeliac artery, paired splanchnic ganglia in the abdominal segments of the greater splanchnic nerves, unpaired superior mesenteric and inter-renal ganglia and the inferior mesenteric ganglia. The projections from the prevertebral sympathetic ganglia to the different parts of the gut were organised somatotopically. The most rostral ganglia (splanchnic, coeliac, and superior mesenteric ganglia) contained neurons innervating all regions of the gastrointestinal tract, the pancreas and the spleen. The inter-renal and inferior mesenteric ganglia, located more caudally, contained neurons innervating the distal part of the gut (distal ileum and colon). The innervation of the spleen and the pancreas came from the closest ganglia (sympathetic chains, splanchnic and coeliac ganglia). This organotopic organisation was not found in the sympathetic chain ganglia; the innervation of all organs came predominantly from the lower part of the thoracic chains. A large proportion of the retrogradely labelled nerve cells in the splanchnic ganglia received nitric oxide synthase immunoreactive innervation probably from the spinal cord. In the other prevertebral ganglia, most of the neurons received nitric oxide synthase immunoreactive innervation and/or bombesin immunoreactive innervation. This leads to the conclusion that, in these ganglia, many neurons receive projections from the gastrointestinal tract in addition to the spinal cord.     

Adrenergic and Cholinergic Innervation of the Rat Urinary Bladder

The autonomic innervation of the rat urinary bladder was studied using histochemical methods and nerve stimulations. A sparse adrenergic innervation of the detrusor muscle was found. It was supposed to originate from long adrenergic neurones. The trigonum area had a rich supply of adrenergic fibres, probably derived from short adrenergic neurones. A uniformly rich supply of acetylcholine-esterase (AChE)-positive nerves was found in the whole bladder. Postganglionic sympathetic denervation caused no detectable change of adrenergic or AChE-positive nerves in the bladder, while parasympathetic decentralization or denervation produced a total disappearance of adrenergic fibres. The AChE-positive nerves were appreciably reduced in number after parasympathetic decentralization and not detectable after postganglionic denervation. Neither adrenergic nor AChE-positive ganglion cells could be demonstrated in the bladder wall. Electrical stimulation of the hypogastric nerves or the pelvic nerves distal to the pelvic ganglia elicited contraction of the detrusor muscle. The responses were not affected by hexamethonium, dihydroergotamine or propranolol but were slightly reduced by guanethidine, reduced to about 40% by atropine and potentiated by eserine. Stimulation of the pelvic nerve proximal to the pelvic ganglion was partially blocked by hexamethonium. It is concluded that the urinary bladder of the rat is supplied by postganglionic adrenergic fibres mainly via the pelvic nerves and only to a lesser extent via the hypogastric nerves. Probably cholinergic fibres pass to the bladder mainly via the pelvic nerves but also via the hypogastric nerves, having their cellbodies outside the bladder wall, partly proximal to the pelvic ganglia.     

Effects of chronic deafferentation on adrenergic ganglion cells and small intensely fluorescent cells

Summary To determine the reaction of adrenergic ganglion cells and small intensely fluorescent (SIF) cells to chronic deafferentation, catecholamine fluorescence of the major pelvic ganglion (MPG) of the rat has been studied following section of the hypogastric nerve, pelvic nerve and sympathetic trunk. Only minor changes occurred following section of the hypogastric nerve; the fluorescence surrounding a few adrenergic ganglion cells became brighter. In contrast, pelvic neurectomy resulted in the appearance of numerous varicose fibres and an increase in the fluorescent intensity of fibres enclosing many ganglion cells. Varicose fibres seem to originate from adrenergic ganglion cells and SIF cells. In many instances, nests of SIF cells gave rise to radially oriented fibres. Removal of the sympathetic trunk appeared to have no effect on the MPG. It is suggested that the appearance of varicose fibres from SIF cells following deafferentation may be due to collateral sprouting of these cells or to the increased fluorescence of pre-existing processes.     

Adrenergic and cholinergic innervation of the rag urinary bladder.

The autonimic innervation of the rat urinary bladder was studied using histochemical methods and nerve stimulations. A sparse adrenergic innervation of the detrusor muscle was found. It was supposed to originate from long adrenergic neurones. The trigonum area had a rich ssupply of adrenergic fibres, probably derived from short adrenergic neurones. A uniformly rich supply of acetylcholine-esterase (AChE)-positive nerves was found in the WHOLE BLADDER. Postganglionic sympathetic denervation caused no detectable change of adrenergic or AChE-positive nerves in the bladder, while parasympathetic decentralization or denervation produced a total disappearance of adrenergic fibres. The AChE-positive nerves were appreciably reduced in number after parasympathetic decentralization and not detectable after postganglionic denervation. Neither adrenergic nor AChE-positive ganglion cells could be demonstrated in the bladder wall. Electrical stimulation of the hypogastric nerves or the pelvic nerves distal to the pelvic ganglia elictied contraction of the detrusor muscle. The responses were not affected by hexamethonium, dihydroergotamine or proparanolol but were slightly reduced by guanethidine, reduced to about 40% by atropine and potentiated by eserine. Stimulation of the pelvic nerve proximal to the pelvic ganglion was partially blocked by hexamethonium. It si concluded that the urinary bladder of the rat is supplied by postganglionic adrenergic fibres mainly via the pelvic nerves and only to a lesser extent via the hypogastric nerves. Probably cholinergic fibres pass to the bladder mainly via the pelvic nerves but also via the hypogastric nerves, having their cellbodies outside the bladder wall, partly proximal to the pelvic ganglia.     

全直肠系膜切除相关盆自主神经的解剖学观察

目的：阐述全直肠系膜切除术相关盆自主神经的局部解剖学特点，探讨盆自主神经保留的部位和对策。方法：对20具男性盆腔固定标本进行解剖观察。结果：腹主动脉丛远离肠系膜下动脉起点；上腹下丛贴近骶岬表面；腹下神经部分毗邻输尿管；盆内脏神经伴行直肠中动脉外侧部；下腹下丛位于直肠系膜后外侧；其直肠侧支走行于直肠侧韧带内，直肠前支向前穿过Denonvilliers筋膜后叶；勃起神经位于Denonvilliers筋膜前叶外侧部。结论：盆自主神经保留的部位是：离断肠系膜下血管时的腹主动脉丛左干，直肠后分离时的上腹下丛和腹下神经，直肠侧面分离时的下腹下丛和盆内脏神经，直肠前分离时的勃起神经。共同原则是：在直肠后间隙中贴近直肠系膜操作；直视下操作；避免过度牵引直肠系膜。     

Topography of the pelvic autonomic nerves in human fetuses between 21-29 weeks of gestation

Summary A topographical study concerning the autonomic nerves in the pelvis of human fetuses was performed by investigating 300–600 m thick sections through fetal pelves, impregnated with the epoxy resin E 12 and cut with a diamond wire-saw. In addition the inferior hypogastric plexus of a 26-week old male fetus was dissected by lateral approach. In 21–29-week old fetuses the pelvic autonomic nerves are relatively thick. Thus the nerves stand out well against surrounding structures and their topographical relationships can exactly be determined. The inferior hypogastric plexus of 21–29-week old fetuses is situated on a curved line between the rectum and the ventrally adjacent structure. It constitutes a rectangular plate, which cannot be subdivided into individual plexuses for the different pelvic organs. The fetal plexus is heavily ganglionated. Large ganglia, forming the so-called ganglion of Frankenhaeuser, are found in the female as well as in the male fetus. In the fetal pelvis the connective tissue compartments are still clearly arranged, because adipose tissue is not yet abundant. The greater part of the inferior hypogastric plexus is situated exactly at the border between a dense visceral tissue medially and a loose parietal tissue laterally. The plexus does not share a common connective tissue cover with the pelvic blood vessels. In fetuses the inferior hypogastric plexus lies in close vicinity to serveral organs, but the pelvic floor is the only region where the nerves can hardly be separated from the surrounding structures.     

Nervous regulation of the tone of the retractor penis muscle in the goat

The nervous control of the retractor penis muscle (rp) was investigated in the anaesthetized goat. Also, isolated field stimulated strips of the muscle were studied. The noradrenaline (NA) and acetylcholine (ACh) content of the rp was determined, and histochemistry for adrenergic and acetylcholinesterase (AChE) positive nerves was performed. The muscle exhibited spontaneous activity that persisted after section of all nerves. There was, however, also a tendency of the activity to follow the general vasomotor tone, which disappeared after section of the sympathetic chains. The excitatory adrenergic nerves which innervate the muscle come from the sympathetic chains and run along the pudendal, the hypogastric and the pelvic nerves. The rp has a dense network of adrenergic fibres and is very sensitive to excitatory adrenergic stimulation. It has a fairly large NA content, which is higher in old goats (5.95 ± 0.42 μg g^-1) than in young goats (2.87 ± 0.78 μg g-¹). Inhibitory non-adrenergic non-cholinergic (NANC) innervation reaches it via the pelvic and the hypogastric nerves. The maximum inhibitory response is reached at low frequencies (2–4 Hz). Cholinergic prejunctional inhibition of the excitatory response to sympathetic chain stimulation was effected by simultaneous stimulation of the hypogastric nerves. In vitro experiments confirmed the presence of endogenous cholinergic muscarinic suppression of the excitatory adrenergic neurotransmission. Significant amounts of ACh (0.81 7 plusmn; 0.18 μg g^-1) are present in the muscle, and it contains strongly AChE positive nerve fibres and nerve cell bodies. It is concluded that the goat rp is innervated by sympathetic adrenergic excitatory nerves and parasympathetic NANC inhibitory nerves. It further has a direct sympathetic inhibitory NANC innervation, and an indirect inhibitory cholinergic innervation which at least in part is sympathetic.     

Principal mechanisms controlling penile retraction and protrusion in rabbits

The effects on penile volume of nerve stimulations and drugs injected into the systemic circulation were studied plethysmographically. Dilator responses at selective perfusion of the penile artery were studied by measuring the perfusion pressure. The main results and conclusions are: The penis has an adrenergic vasoconstrictor supply coming from the sacrococcygeal parts of the sympathetic chains. A very low (0.2 Hz) vasomotor tone keeps the penis relaxed. If this tone is interrupted the penis will protrude but autoregulation will soon take over and eventually produce hyperinvolution of the penis. Two vasodilator paths, both with pelvic ganglionic relays, were found. 1) The pelvic parasympathetic nerves, probably having mainly non-cholinergic postganglionic neurons and operating quite effectively at low frequencies. 2) The sympathetic hypogastric nerves, presumably having at least partly cholinergic postganglionic neurons which, apart from muscarinic dilation of minute inflow resistance vessels to the erectile tissue, may also work by suppression of excitatory adrenergic neurotransmission. The pelvic and hypogastric vasodilator outflows work synergistically. The vasoconstrictor nerves are very strong and efficient antagonists of the vasodilator nerves.     

Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis

Bladder, bowel, and sexual dysfunction caused by iatrogenic lesions of the inferior hypogastric plexus (IHP) are well known and commonly tolerated in pelvic surgery. Because the pelvic autonomic nerves are difficult to define and dissect in surgery, and their importance often ignored, we conducted a gross anatomic study of 90 adult and four fetal hemipelves. Using various non-surgical approaches, the anatomic relations and pathways of the IHP were dissected. The IHP extended from the sacrum to the genital organs at the level of the lower sacral vertebrae. It originated from three different sources: the hypogastric nerve, the sacral splanchnic nerves from the sacral sympathetic trunk (mostly the S2 ganglion), and the pelvic splanchnic nerves, which branched primarily from the third and fourth sacral ventral rami. These fibers converge to form a uniform nerve plate medial to the vascular layer and deep to the peritoneum. The posterior portion of the IHP supplied the rectum and the anterior portion of the urogenital organs; nerve fibers traveled directly from the IHP to the anterolateral wall of the rectum and to the inferolateral and posterolateral aspects of the urogenital organs. The autonomic supply from the IHP was supplemented by nerves accompanying the ureter and the arteries. An understanding of the location of the autonomic pelvic network, including important landmarks, should help prevent iatrogenic injury through the adoption of surgical techniques that reduce or prevent postoperative autonomic dysfunction.     

男性盆腔内脏神经的解剖学研究及其临床意义

男性盆腔内脏神经与盆筋膜及盆内脏器的毗邻关系复杂,且个体形态学差异大,临床上涉及肛肠外科、泌尿外科、男科等多个学科,应用甚广。近年来,对内脏神经的术中保护越来越受到重视。男性盆腔内脏神经主要包括上腹下丛、腹下神经、下腹下丛(即盆丛)、盆内脏神经、膀胱丛、前列腺丛、直肠丛及其分支等。现已证明盆腔内脏神经的损伤会给患者的排便、排尿及阴茎勃起等造成功能障碍。熟悉男性盆腔内脏神经及其分支的形态特点及其与周围结构的关系,能降低手术并发症,提高患者术后生活质量。     

Coexistence of adrenergic and cholinergic nerves in the inferior hypogastric plexus: anatomical and immunohistochemical study with 3D reconstruction in human male fetus

Classic anatomical methods have failed to determine the precise location, origin and nature of nerve fibres in the inferior hypogastric plexus (IHP). The purpose of this study was to identify the location and nature (adrenergic and/or cholinergic) of IHP nerve fibres and to provide a three-dimensional (3D) representation of pelvic nerves and their relationship to other anatomical structures. Serial transverse sections of the pelvic portion of two human male fetuses (16 and 17 weeks' gestation) were studied histologically and immunohistochemically, digitized and reconstructed three-dimensionally. 3D reconstruction allowed a 'computer-assisted dissection', identifying the precise location and distribution of the pelvic nerve elements. Proximal (supra-levator) and distal (infra-levator) communications between the pudendal nerve and IHP were observed. By determining the nature of the nerve fibres using immunostaining, we were able to demonstrate that the hypogastric nerves and pelvic splanchnic nerves, which are classically considered purely sympathetic and parasympathetic, respectively, contain both adrenergic and cholinergic nerve fibres. The pelvic autonomic nervous system is more complex than previously thought, as adrenergic and cholinergic fibres were found to co-exist in both 'sympathetic' and 'parasympathetic' nerves. This study is the first step to a 3D cartography of neurotransmitter distribution which could help in the selection of molecules to be used in the treatment of incontinence, erectile dysfunction and ejaculatory disorders.     

Reflex firing in the lumbar sympathetic outflow to activation of vesical afferent fibres

1. Activation of vesical afferent fibres in the Aγδ range by electrical stimulation of the pelvic nerve or by bladder distension elicited reflex firing in hypogastric nerves and in preganglionic nerves to the inferior mesenteric ganglion.

2. The multisynaptic reflex was present in cats with an intact spinal cord and in acute and chronic spinal animals (transections at T10—T12). The reflex pathway was partially crossed in the sacral cord, and in the periphery at the level of the inferior mesenteric ganglia. In contrast, an inhibitory response to raised intravesical pressure was mediated by a supraspinal inhibitory mechanism which was activated in parallel with the micturition reflex.

3. Since enhancement as well as depression of sympathetic firing accompanied reflex micturition, it is concluded that at least two distinct populations of lumbar preganglionic neurones are responsive to vesical afferent activity: one population being excited, the other depressed, during micturition. The latter population may be involved in an inhibitory feed-back mechanism on to the bladder.

     

The ramifications of adrenergic nerve terminals in the rectum, anal sphincter and anal accessory muscles of the guinea-pig

Summary The anatomy and the adrenergic innervation of the rectum, internal anal sphincter and of accessory structures are described for the guinea-pig. The distribution of adrenergic nerves was examined using the fluorescence histochemical technique applied to both sections and whole mount preparations. The longitudinal and circular muscle of the rectum and the muscularis mucosae are all supplied by adrenergic nerve terminals. The density of the adrenergic innervation of the muscularis externa increases towards the anal sphincter. There is a very dense innervation of the internal anal sphincter, of the anal accessory muscles and of the corrugator ani. Non-fluorescent neurons in the ganglia of the myenteric plexus are supplied by adrenergic terminals. The ganglia become smaller and sparser towards the internal anal sphincter and non-ganglionated nerve strands containing adrenergic axons run from the plexus to the sphincter muscle. Adrenergic fibers innervate two interconnected ganglionated plexuses in the submucosa. Very few adrenergic nerve cells were found in the myenteric plexus and they were not found at all in the submucosa. The extrinsic arteries and veins of the pelvic region are heavily innervated by adrenergic nerves. Within the gut wall the arteries are densely innervated but there is little or no innervation of the veins.This work was supported by grants from the Australian Research Grants Committee and the National Health and Medical Research Council. We thank Professor G. Burnstock for his generous support.     

Changes in the Amount of Adrenergic Transmitter in the Female Genital Tract-of Rabbit During Pregnancy

The noradrenaline present in the female reproductive organs – ovary, oviduct, uterus, and vagina – of the rabbit is stored in adrenergic nerves. Fluorescence microscopy revealed that these nerves are related to the vascular bed and the smooth muscle walls; besides the vascular nerves the ovary also contains adrenergic nerves unrelated to the vessels. The adrenergic innervation of the genital organs originates from sympathetic ganglia located near the effector organs, as well as from pre- and paravertebral ganglia. During the former half of pregnancy a marked increase in neuronal noradrenaline occurs in the reproductive organs, except in the ovary. In the uterus and the vagina this increase is followed by a dramatic decrease in total noradrenaline during the latter half of pregnancy; by the end of pregnancy the uterus is almost completely devoid of noradrenaline-containing sympathetic nerves. The findings are discussed in terms of an humoral influence on the adrenergic neurons supplying the female reprocluctive tract.     

The anatomy of the infrarenal lumbar splanchnic nerves in human cadavers: implications for retroperitoneal nerve‐sparing surgery

Injury to the nerves of the aortic‐ and superior hypogastric plexuses during retroperitoneal surgery often results in significant post‐operative complications, including retrograde ejaculation and/or loss of seminal emission in males. Although previous characterizations of these plexuses have done well to provide a basis for understanding the typical anatomy, additional research into the common variations of these plexuses could further optimize nerve‐sparing techniques for retroperitoneal surgery. To achieve this, the present study aimed to document the prevalence and positional variability of the infrarenal lumbar splanchnic nerves (LSNs) through gross dissection of 26 human cadavers. In almost all cases, two LSNs were observed joining each side of the aortic plexus, with 48% (left) and 33% (right) of specimens also exhibiting a third joining inferior to the left renal vein. As expected, the position of the LSNs varied greatly between specimens. That said, the vast majority (98%) of LSNs joining the aortic plexus were found to originate from the lumbar sympathetic trunk above the level of the inferior mesenteric artery. It was also found that, within specimens, adjacent LSNs often coursed in parallel. In addition to these nerves, 85% of specimens also demonstrated retroaortic LSN(s) that were angled more inferior compared with the other LSNs (P < 0.05), and exhibited a unique course between the aorta/common iliac arteries and the left common iliac vein before joining the superior hypogastric plexus below the aortic bifurcation. These findings may have significant implications for surgeons attempting nerve‐sparing procedures of the sympathetic nerves in the infrarenal retroperitoneum such as retroperitoneal lymphadenectomies. We anticipate that the collective findings of the current study will help improve such retroperitoneal nerve‐sparing surgical procedures, which may assist in preserving male ejaculatory function post‐operatively.