The cavernous nerves (nervi cavernosi) arise from the pelvic (inferior hypogastric) plexus and run in the neurovascular bundles of Walsh along the posterolateral prostate (at about the 5 and 7 o'clock positions) and then beside the membranous urethra to enter the corpora cavernosa of the penis, or the clitoris in females. Their parasympathetic fibres (S2-S4) trigger erection by releasing nitric oxide, which relaxes the smooth muscle of the erectile tissue and lets it fill with blood; they also carry sympathetic fibres.
| Origin | Inferior hypogastric (pelvic) plexus, carrying parasympathetic fibres from S2-S4 |
|---|---|
| Course | Run within the neurovascular bundles posterolateral to the prostate and seminal vesicles (or alongside the vagina), pierce the urogenital diaphragm, and enter the corpora cavernosa |
The cavernous nerves are the key structures for preserving erectile function in radical prostatectomy. The Walsh nerve-sparing technique keeps the neurovascular bundles intact by dissecting in the interfascial or intrafascial plane next to the prostate, between it and Denonvilliers fascia, before the urethra is divided. Erectile recovery depends on preoperative function and on whether one or both bundles are spared, and usually takes many months. The nerves are hard to see directly, so surgeons rely on the fascial planes, and some centres use nerve mapping.
Division or thermal injury to the cavernous nerves during radical prostatectomy produces erectile dysfunction in the early post-operative period; nerve-sparing technique preserves the neurovascular bundles along the posterolateral prostate in Denonvilliers plane, with erectile function recovery taking 6-18 months as the neuropraxia resolves, aided by penile rehabilitation with PDE5 inhibitors.
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