During radical prostatectomy, which structure is at greatest risk for injury?

During radical prostatectomy, which structure is at greatest risk for injury?

• A. Pelvic parasympathetic plexus
• B. Pudendal nerve
• C. Superior hypogastric plexus
• D. Obturator nerve

Answer: (A)

Erection relies on parasympathetic signals carried by the pelvic autonomic nerves that run in the pelvic neurovascular bundles beside the prostate. These fibers—the pelvic parasympathetic plexus from the S2–S4 pelvic splanchnic nerves—send signals to the cavernous smooth muscle to produce tumescence. During radical prostatectomy, these nerves lie close to the prostate and are easily endangered by dissection, so they are the structures most at risk. Injuring them can lead to erectile dysfunction because the essential parasympathetic drive for penile erection is lost. The pudendal nerve provides somatic innervation to the perineum and external sphincters and is not the primary concern for erectile function in this procedure. The superior hypogastric plexus carries sympathetic fibers and can affect ejaculation and bladder function but is less commonly the main target of injury in prostatectomy. The obturator nerve runs along the lateral pelvic wall and would affect thigh adduction if injured, not erectile function.

Erection relies on parasympathetic signals carried by the pelvic autonomic nerves that run in the pelvic neurovascular bundles beside the prostate. These fibers—the pelvic parasympathetic plexus from the S2–S4 pelvic splanchnic nerves—send signals to the cavernous smooth muscle to produce tumescence. During radical prostatectomy, these nerves lie close to the prostate and are easily endangered by dissection, so they are the structures most at risk. Injuring them can lead to erectile dysfunction because the essential parasympathetic drive for penile erection is lost. The pudendal nerve provides somatic innervation to the perineum and external sphincters and is not the primary concern for erectile function in this procedure. The superior hypogastric plexus carries sympathetic fibers and can affect ejaculation and bladder function but is less commonly the main target of injury in prostatectomy. The obturator nerve runs along the lateral pelvic wall and would affect thigh adduction if injured, not erectile function.