Mp80-07 microscopical analysis of fresh prostate specimens: preliminary findings about nerve distribution on prostate apex

You have accessJournal of UrologyCME1 Apr 2023MP80-07 MICROSCOPICAL ANALYSIS OF FRESH PROSTATE SPECIMENS: PRELIMINARY FINDINGS ABOUT NERVE DISTRIBUTION ON PROSTATE APEX Simone Assumma, Maria Chiara Sighinolfi, Tommaso Calcagnile, Enrico Panio, Luca Sarchi, Mattia Sangalli, Filippo Turri, Matteo Maggioni, Igor Piacentini, Paolo Marcangeli, Giulia Garelli, Daniele Stroppa, Carlo Pescia, Alessia Moro, Claudia Cigala, Alessia Cimadamore, Matteo Barabino, Giorgio Bozzini, Salvatore Micali, Angelica Grasso, Paolo Dell'Orto, Alberto Del Nero, and Bernardo Rocco Simone AssummaSimone Assumma More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Tommaso CalcagnileTommaso Calcagnile More articles by this author , Enrico PanioEnrico Panio More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Mattia SangalliMattia Sangalli More articles by this author , Filippo TurriFilippo Turri More articles by this author , Matteo MaggioniMatteo Maggioni More articles by this author , Igor PiacentiniIgor Piacentini More articles by this author , Paolo MarcangeliPaolo Marcangeli More articles by this author , Giulia GarelliGiulia Garelli More articles by this author , Daniele StroppaDaniele Stroppa More articles by this author , Carlo PesciaCarlo Pescia More articles by this author , Alessia MoroAlessia Moro More articles by this author , Claudia CigalaClaudia Cigala More articles by this author , Alessia CimadamoreAlessia Cimadamore More articles by this author , Matteo BarabinoMatteo Barabino More articles by this author , Giorgio BozziniGiorgio Bozzini More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Angelica GrassoAngelica Grasso More articles by this author , Paolo Dell'OrtoPaolo Dell'Orto More articles by this author , Alberto Del NeroAlberto Del Nero More articles by this author , and Bernardo RoccoBernardo Rocco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies focusing on macroscopical shape and microscopical features have been conducted for decades to evaluate the anatomy of prostate apex. A initial description of nerve distribution along the prostatic capsule was provided by Eichelberg et al. (Eur Urol, 2007), highlighting a non-negligible number of nerves on the ventral part of the prostate. Authors recommended a high incision to achieve a nerve sparing technique on the anterior portion of the prostate, as a result of surgical evidence. While previous microscopical analyses were focused on specimens undergoing previous formalin-fixation and paraffin-embedding, the present study aims to assess apical microscopical anatomy on fresh samples, through the use of ex-vivo fluorescence confocal microscopy. METHODS: Eleven slides from 9 patients undergoing non nerve-sparing robotic radical prostatectomy have been prospectively collected and analyzed. Following the acquisition of 1-mm transverse sections of the prostate apex, each specimen was stained in Acridine Orange for 30 seconds and then examined through fluorescence confocal microscopy (Vivascope, Mavig). Slides were split into sectors, similar to Eichelberg study: anterior, mid-lateral and postero-lateral aspects were investigated on each side of the slides. The main goal is to determine the amount of nerves surrounding each aspect of the apex. All slides were examined by two pathologists, an expert and a trainee (AC and CP), who counted every single nerve and ganglion on apical perimeter and in the peri-prostatic tissue. RESULTS: Around the apical circumference, a total of 81 nerves were found. The majority (72%) of the nerves were detected in the postero-lateral region of prostatic apex (58), 22% in the lateral part (18) and 6% only (5 nerves) in anterior apex. Regarding the nerve count, there was a satisfactory level of agreement (K value of 0.75) between pathologists. In 4/11 slices, a segmental pseudocapsule composed by connective and muscle tissue was visible. CONCLUSIONS: To our knowledge, this is the very first depiction of nerve distribution on prostate apex on fresh specimens. In contrast with Eichelberg’s findings, in the anterior and mid-lateral aspects of the apex, an inferior amount of nerves was found. Despite the limited number of cases now available, a possible explanation for our discovery is the lack of shrinkage brought on by formalin fixation. Further research is encouraged to learn more about the location of the nerves on fresh material and to potentially guide surgical techniques for apical dissection. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1154 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simone Assumma More articles by this author Maria Chiara Sighinolfi More articles by this author Tommaso Calcagnile More articles by this author Enrico Panio More articles by this author Luca Sarchi More articles by this author Mattia Sangalli More articles by this author Filippo Turri More articles by this author Matteo Maggioni More articles by this author Igor Piacentini More articles by this author Paolo Marcangeli More articles by this author Giulia Garelli More articles by this author Daniele Stroppa More articles by this author Carlo Pescia More articles by this author Alessia Moro More articles by this author Claudia Cigala More articles by this author Alessia Cimadamore More articles by this author Matteo Barabino More articles by this author Giorgio Bozzini More articles by this author Salvatore Micali More articles by this author Angelica Grasso More articles by this author Paolo Dell'Orto More articles by this author Alberto Del Nero More articles by this author Bernardo Rocco More articles by this author Expand All Advertisement PDF downloadLoading ...