Gross and light microscopic features of the pelvic plexus in the rat.
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Animals↗
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Involvement of the pelvic plexus and the suprarenal ganglia in the neuropeptide Y (NPY) innervation of the cervix and the uterus of the rat.
The involvement of the pelvic plexus and suprarenal ganglia in the neuropeptide Y (NPY) innervation of the genital tract was studied in the female rat by means of denervation experiments and retrograde tracing studies. Removal of the paracervical ganglia caused a significant decrease of the NPY-immunoreactive nerve density and NPY concentration in the lower part of the genital tract: cervix, uterine body and lower part of the uterine horn. The decrease in NPY concentration in these three regions was more pronounced after lesion of the pelvic plexus. Lesion of the ovarian nerve plexus caused a depletion in the NPY-immunoreactive nerve fibres and a decrease in NPY concentration in the upper part of the uterine horn. Pelvic nerve section, inferior mesenteric ganglia excision and superior ovarian nerve section had no effect on the NPY innervation in the genital tract. Injection of fluorogold into the cervix and lower part of the uterus combined with immunohistochemistry revealed that 87.5% of labelled neurons in the pelvic plexus were NPY-immunoreactive. Following injection of fluorogold into the upper part of the uterus, 92% of labelled neurons in the suprarenal ganglia were NPY-immunoreactive. Treatment with 6-hydroxydopamine revealed that the NPY-immunoreactive nerve fibres were non-noradrenergic in the cervix, but were noradrenergic in the upper part of the uterus. In the uterine body and lower part of the uterine horn, both noradrenergic and non-noradrenergic NPY-immunoreactive nerve fibres were observed. These data demonstrate the major contribution of pelvic plexus neurons in the non-noradrenergic NPY innervation of the lower part of the genital tract, and the involvement of the suprarenal ganglia in the noradrenergic NPY innervation of the upper part of the uterus via the ovarian nerve plexus.
Animals↗
[Differentiation of neurons of the pelvic plexus in humans in the period of prenatal and early postnatal ontogenesis].
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Cell Differentiation↗
Anatomic study of lateral pelvic lymph nodes: implications in the treatment of rectal cancer.
PURPOSE: Lateral pelvic lymphadenectomy remains a controversial issue in rectal cancer surgery. Beyond clinical results, disagreement includes surgical anatomy aspects and definitions, as wells as lack of information about location, groups, and number of lymph nodes, all of which makes comparison of results difficult. We performed a systematic examination of the number and distribution of lateral pelvic lymph nodes using cadaveric dissection. METHODS: Sixteen formalin-fixed cadavers were dissected (14 males). Dissection fields were divided according to the three surgical groups of pelvic wall lymph nodes: presacral, obturator, and hypogastric. Number and site of excised lymph nodes was recorded, noting neurovascular relationships. RESULTS: A total of 458 lymph nodes were found, with a mean of 28.6 nodes per pelvis (range, 16-46). Lymph node size ranged from 2 to 13 mm. The highest number of lymph nodes was found in the obturator fossa group (mean, 7; range, 2-18). Hypogastric lymph nodes were found lying predominantly above the inferior hypogastric nerve plexus but reaching the deep pelvic veins. CONCLUSIONS: The mean number of lymph nodes found in lateral pelvic wall compartments was 28.6 per specimen. The group containing most lymph nodes lies in the obturator fossa. Complete excision of hypogastric lymph nodes demands a deep pelvic dissection of neurovascular structures.
Aged↗
[Urinary continence in patients undergoing nerve sparing radical prostatectomy].
Recently, the morbidity of radical prostatectomy has been reduced by improvements in surgical techniques and greater understanding of pelvic anatomy. The nerve sparing technique has been considered to be a major contribution to this advance. In our study, urinary control was compared in 33 consecutive patients undergoing a radical retropubic prostatectomy. In 13 patients, a conventional radical prostatectomy was performed and in 20 subsequent patients, a nerve sparing operation was performed. The staff surgeons were the same throughout the study. The age of the patients and pathological stage of the tumor were not significantly different between the groups. The operative time was shorter and intraoperative blood loss was less both significantly in the nerve sparing group. In the conventional operated group, there was one patient with total incontinence and two with significant incontinence requiring absorbable pads. In the nerve sparing group, there were no patients having total incontinence and one had stress incontinence requiring absorbable pads. Urethral pressure profile was measured postoperatively in 17 in the nerve sparing group and in 7 in the conventional group. The maximum urethral pressure in the nerve sparing group was 31.5 cm H2O (SD = 5.4) and in the conventional group 23.2 cm H2O (SD = 5.7) with a significant difference between groups (p less than 0.01). The functional urethral length of the nerve sparing group was 16.7 mm (SD = 5.2) and in the conventional group 13.3 mm (SD = 3.7) with no significant difference between the groups. These results suggest that preservation of neurovascular bundles from the pelvic plexus during radical prostatectomy has no important role in postoperative urinary continence.
Aged↗
Acupuncture points of the lumbar plexus.
This communication is the fifth in a series of six publications describing acupuncture points by anatomic nomenclature. This article describes acupuncture points in the lumbar region of the posterior body wall, the inguinal and pelvic regions of the lower abdomen, and the medial surface of the thigh and leg. Acupuncture points in these regions are generally established by anatomic features of the lumbar spinal nerves. Nerve branches of the posterior primary rami of the lumbar spinal nerves and the lumbar plexus provide the anatomic basis for acupuncture points in these regions and are used to name the points accordingly.
Acupuncture Therapy↗
Re: the pelvic plexus and antireflux surgery: topographical findings and clinical consequences. J. Leissner, E.P. Allhoff, W. Wolff, C. Feja, M. Höckel, P. Black, and R. Hohenfellner. J Urol, 165: 1652-1655, 2001.
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Humans↗
Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: left-right communicating nerves between bilateral pelvic plexuses.
PURPOSE: Some recent neurophysiological studies have suggested cross-innervation of pelvic genitourinary organs by extrinsic left-right communicating nerves. However, no definite course for these nerves has been clearly determined macroanatomically in humans. In the present study we extensively investigated the adult human pelvis to elucidate their courses by the whole-mount staining method. MATERIALS AND METHODS: A total of 6 male human specimens that had been subjected to pathological dissection were examined by means of an acetylcholinesterase whole-mount staining method. A map of nerve pathways was made by composite photomicrography. Histologically, nerves dissected accurately under a dissecting microscope were stained with both Klüver-Barrera stain and the Bodian method. RESULTS: The communicating nerves between bilateral pelvic plexuses were observed at the back of the rectum and in the rectoprostatic space. The former were composed of nothing but myelinated fibers in the same way as the pelvic splanchnic nerve. By contrast, the latter were composed of unmyelinated fibers with a few myelinated fibers. The pelvic plexus could be divided into three portions, anterosuperior, anteroposterior and inferior areas, by ganglion type. Morphologically, fiber components differed among those three portions. CONCLUSION: The communicating nerves at the back of the rectum seemed to be predominantly parasympathetic communicantes between bilateral pelvic splanchnic nerves rather than pelvic plexuses. These nerves may be involved in postoperative voiding function in the case of pelvic surgery with hemilateral nerve preservation. The function of the pelvic plexus seemed to be heterogeneous in each portion according to our morphological results.
Aged↗
[Development of nerves plexuses in the pelvis of the prenatal rabbit].
By means of neurohistological and histochemical methods using serial sections of the embryos at the age of 12-30 days of development, the premediatory and beginning of the mediatory stages in development of cholinergic and adrenergic neural plexuses have been studied in rabbit small pelvis. Appearance of catecholamine-containing cells at early mediatory stages and a gradual development and complication of the cholinergic and adrenergic neural plexuses structure are demonstrated. By birth in the rabbit small pelvis area, some elements of cholinergic and adrenergic structures begin to form.
Adrenergic Fibers↗
Diagnosis of pregnancy-associated uterine venous plexus thrombosis on the basis of transvaginal sonography.
OBJECTIVE: To describe the sonographic signs of uterine venous plexus thrombosis. METHODS: Four pregnant patients had a diagnosis of uterine venous plexus thrombosis in the first half of gestation. The diagnosis was based on transvaginal sonography only in 3 cases, and the fourth had magnetic resonance imaging corroboration. RESULTS: All 4 patients had similar sonographic features of uterine venous plexus thrombosis on transvaginal sonographic examination. The thrombi within the dilated veins were shown as elongated echogenic structures along the lumen that appeared round on transverse views of the affected veins. They showed swinging movements provoked by gentle transducer pressure. Power and color Doppler sonography enhanced the uterine venous plexus thrombosis diagnosis by showing blood flow around the thrombi. There were no signs of thromboembolic disease. Sonographic findings in deep leg veins and iliac veins were normal in all cases. Complete thrombophilia studies did not reveal any abnormalities. The uterine venous plexus thrombosis could not be detected on transabdominal sonography and was shown better by transvaginal sonography compared with magnetic resonance imaging. During 3 months of anticoagulation therapy, the thrombi gradually disappeared in all cases. CONCLUSIONS: Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.
Adult↗
Anatomy of the nerve supply of the rectum, bladder, and internal genitalia in anorectal dysgenesis in the male.
Using a posterior sagittal approach to expose retroperitoneal viscera and nerves, the anatomy of the pelvic autonomic nerve plexus was studied in normal and abnormal male cadaver specimens. This plexus is found on the anterolateral surface of the lower rectum surrounded by endopelvic fascia. The autonomic nerves that supply the plexus reach it from posterior, lateral to the midline by passing over the surface of the rectum. The nerves of this plexus are distributed with the terminal branches of the internal iliac arteries, mainly with the vessels of the inferior vesical plexus. The rectum receives its autonomic nerves with its arterial blood supply, the superior rectal artery. The nerves of the pelvic plexus supply the genitourinary viscera that lie anterior to the rectum and in front of the fascia of Denonvilliers. The named fascial layers of the pelvis play a major role in determining the anatomic plane of these structures. In anorectal agenesis the plexus becomes a more midline structure. Because the pelvic fascia is often deficient in these cases these nerves lie vulnerable to inappropriate midline dissection.
Anal Canal↗
Urodynamic features of pelvic plexus injury.
Benign and malignant neoplasms arising in and around the pelvic structures may cause urinary obstruction by mechanical compression of the bladder or proximal urethra. These neoplasms less commonly cause neurogenic voiding dysfunction. Herein we describe the urodynamic abnormalities in a young man with massive involvement of the true pelvis with choriocarcinoma. Destruction of the pelvic plexus produced deficits of parasympathetic, sympathetic and somatic innervation of the bladder and urethra. The value of urodynamic evaluation as a neurologic test of thoracolumbar and sacral cord function is demonstrated.
Adolescent↗
[Careful dissection of the pelvic plexus helps alleviate urinary retention following radical hysterectomy].
Radical hysterectomy remains to be the treatment of choice for carcinoma of the uterine cervix. As pelvic nerve plexuses are distributed in the operative field, damage to the plexuses is likely to occur, which is responsible for the post-operative atonia of the urinary bladder and urinary retention. To reduce the incidence of this postoperative complication, the composition and distribution of the pelvic nerve plexuses in relation to the utero-sacral ligament and cardinal ligament of the uterus and paravaginal tissues were carefully dissected on 11 adult female cadavers. Based on the anatomic study, due precautions were made to avoid damage to the pelvic nerve plexuses during pelvic dissection for radical hysterectomy. As a result, the duration of postoperative urinary retention was significantly reduced while the 5- and 10-year survival rates remained unchanged.
Adult↗
Neuro-pharmacologic studies on neurogenic bladder after radical hysterectomy.
Miction function of patients who had had radical hysterectomy was investigated neuro-pharmacologically. The patients were divided into two groups according to the operation, with or without preservation of the plexus pelvicus, and bladder and urethral functions were compared by the bethanechol test and phentolamine test. The group with transected plexus pelvicus showed neurogenic bladder with impairment of functions of parasympathetic and sympathetic nerves and the preserved group showed much less impairment in functions of both nerves.
Adult↗
Change in colonic motility after extrinsic autonomic denervation in dogs.
Changes in colonic motility were compared in dogs undergoing autonomic denervation of the paraaortic and presacral (group A), paraaortic (group B), or mesocolonic region (group C), and sham operation (group D). Five bipolar recording electrodes were placed into the seromuscular layer of the colon and rectum. The numbers of continuous electrical response activity and contractile electrical complex after an intragastric olive oil injection were smaller in group A than in the other groups (P < 0.05) from three weeks through six months after denervation. This difference was significant even in the proximal colon. These data suggest that the pelvic plexus may play an important role in colonic motility including the proximal colon. The damage to the plexus did not recover for at least six months after denevation. Pelvic plexus injury may thus be one of possible explanations for the prolonged change in bowel habit after anterior resection of the rectum.
Animals↗
Does the cardinal ligament of the uterus contain a nerve that should be preserved in radical hysterectomy?
The cardinal ligament (CL) of the uterus is present as a specific part of the parametrium when the pararectal and paravesical spaces are developed surgically. According to usual nerve-sparing radical hysterectomy (the Tokyo method), the CL is divided into two parts, the vascular part for dissection and the nerve part that contains the pelvic splanchnic nerve (PSN) as a major target for nerve sparing. In contrast, we hypothesized that the CL and another structure outside of the usual area for surgical dissection, that is, the lateral rectal ligament, are mutually continuous and that the PSN runs through the lateral ligament rather than the CL. In the present study, a combination of routine dissection, fresh cadaver dissection and in situ sectional anatomy revealed that: (i) the CL did not contain the PSN; (ii) a well-defined fascial structure existed in the bottom or dorsal margin of the CL area; and (iii) the pelvic plexus was separated from vascular components of the CL. The present results provide a new perspective for nerve-sparing radical hysterectomy with extensive lateral parametrial dissection of the CL.
Aged↗
[The indications for autonomic nerve-sparing surgery in rectal cancer patients].
Although extended lymph node dissection was developed to improve the therapeutic result in advanced rectal cancer in the 1970s, postoperative dysfunction remained problematic. Informed consent of cancer is generalized at present. The balance between complete cure and functional preservation is important. Therefore the autonomic nerve-sparing surgical technique for rectal cancer was introduce din the 1980s. The success of nerve-sparing surgery depends on a thorough knowledge of pelvic anatomy, especially the anatomic relationship between the pelvic plexus and internal intestinal vessels. Further investigation is required to clarify the indications for autonomic nerve-sparing surgery in rectal cancer patients.
Autonomic Nervous System↗
Neuropathy following paracervical block in the obstetric patient.
A distinct clinical syndrome of severe buttock pain radiating down the posterior surface of the ipsilateral leg and subsequent inability to ambulate has recently been recognized. The syndrome may develop in the parturient following a paracervical block. This study analyzes 4 cases from the authors' institution and reviews 2 cases from the literature. Onset of the syndrome ranges from 12 hours to 10 days but progressive improvement and complete recovery are the rule. The cause is believed to be secondary to direct trauma or hematoma formation in the area of the sacral plexus. Pelvic induration or a mass in the sacroiliac area may be noted bur abscess formation is not associated. Prevention is difficult but early recognition will facilitate treatment, which is mostly symptomatic.
Adolescent↗