[Preservation of the hypogastric plexus in excisional interventions on the rectum for neoplasms].
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Adult↗
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Superior hypogastric plexus block using a single needle and computed tomography guidance.
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Autonomic Nerve Block↗
Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision.
PURPOSE: Given the improvement in oncologic outcome after the introduction of total mesorectal excision for the treatment of rectal cancer, the objective of the present study was to determine the frequency of identification and preservation of the pelvic autonomic nerves and to identify a possible link between postoperative micturition disturbances and the extent of the radical resection. METHODS: Between March 1997 and December 2001, 150 patients with adenocarcinoma of the rectum (<or=16 cm from the anal verge) underwent surgery, with sphincter preservation in 112 cases (74.7 percent). Sixty-three patients (42 percent) were classified as American Society of Anesthesiologists Stage III and two (1.3 percent) as Stage IV. The number of cases with complete identification, partial identification, or nonidentification of the autonomic nerves (superior hypogastric plexus, hypogastric nerve, and inferior hypogastric plexus) was documented and correlated with micturition disturbances (need for a long-term urinary catheter). Urine volumes were measured by ultrasound before and after surgery. RESULTS: The pelvic autonomic nerves were identified completely in 108 patients (72 percent), partially in 16 (10.7 percent), and not at all in 26 (17.3 percent). After the initial phase of the study (n = 50 patients), complete identification was realized in 78 percent of cases. Multivariate analysis showed that of the predetermined parameters (learning curve for Group I vs. Groups II or III, gender, T stage, blood loss, curative surgery, and previous surgery), gender (P = 0.006), learning curve (P = 0.019), and depth of penetration of the rectal wall (T1/T2 vs. T3/T4; P = 0.028) exerted an independent influence on achievement of complete pelvic nerve identification. Sixteen patients (10.7 percent) were discharged from the hospital with a urinary catheter. Identification and preservation of the pelvic autonomic nerves was associated with low bladder dysfunction rates (4.5 vs. 38.5 percent; P < 0.001). In the evaluation of preoperative and postoperative bladder function, a urologic history and residual urine volume measurements by ultrasound were essential. The information obtained from urodynamic studies was of no relevance. CONCLUSIONS: Identification and preservation of the pelvic autonomic nerves was achieved in the majority of patients and led to the prevention of urinary dysfunction. Gender (P = 0.006), learning curve (P = 0.019), and T stage are independent parameters that influence outcome.
Adenocarcinoma↗
Nerve-sparing surgery in 302 resectable rectosigmoid cancer patients: genitourinary morbidity and 10-year survival.
PURPOSE: The aim of this study was to evaluate 5-year and 10-year disease-free survival, urinary dysfunction, and sexual activity after nerve-sparing radical surgery, including lumboaortic lymphadenectomy for rectosigmoid cancer. METHODS: Since 1980 to 1992, 302 consecutive patients affected with rectal (188) or sigmoid (114) resectable cancer underwent radical surgery. Lumboaortic lymphadenectomy was routinely performed and total mesorectal dissection was always accomplished in rectal cancer. Splanchnic nerves, superior hypogastric plexus, hypogastric nerves, and sacral parasympathetic nerves were sought, identified, and preserved or, when necessary, unilaterally sacrificed. Fifty-three (17.6 percent) patients were classified Dukes A, 145 (48.0 percent) B, 46 (15.2 percent) C1, and 17 (5.6 percent) C2. Thirty-nine (12.9 percent) patients were Dukes D. In 85 rectal cancer patients, tumor was located at the lower third. Eighty-six of 210 Dukes B and C patients were submitted to systemic chemotherapy and/or high-dose pelvic radiotherapy. RESULTS: The actuarial 5-year disease-free survival was 58.5 percent in rectal and 65.7 percent in sigmoid cancer patients, median follow-up time was 47 months. During the follow-up, each patient was interviewed about sexual activity and urinary dysfunction and a questionnaire was filled out. Urinary dysfunction was not frequently observed, while a definitive sexual impotence was reported in 27.6 percent of the patients. The age under 60 years and sphincter-saving surgery were demonstrated as significantly contributing to retaining a satisfactory sexual activity. CONCLUSIONS: Unexpectedly high disease-free survival was observed in the Dukes C2 subgroup. It allows us to hypothesize that lumboaortic lymphadenectomy could remove neoplastic microfoci present at this level in those patients, enhancing surgical chances of cure. The majority of male patients under 60 years old can retain a satisfactory sexual activity after undergoing a nerve-sparing sphincter-saving cancer surgery.
Adult↗
Hypogastric nerve preservation does not increase local recurrence after surgical treatment of rectal carcinoma.
BACKGROUND/AIMS: The main aim of the study was to evaluate whether superior hypogastric plexus and hypogastric nerve can be preserved without increasing local recurrence while performing surgical treatment of rectal carcinoma. METHODOLOGY: This was a retrospective study of 129 patients with rectal carcinoma who underwent curative resection with two types of autonomic nerve-sparing operation. The superior hypogastric plexus and bilateral hypogastric nerves were resected in 61 patients and spared in 68 patients. The pelvic plexus was preserved in all the patients. Local recurrence and survival were compared between two operations. RESULTS: After three years, local recurrence cumulative rates were 13.1% after hypogastric nerve removing operation and 10.3% after hypogastric nerve preserving operation. Distant metastasis and corrected 5-year survival rates were 23.0 and 61.6%, respectively after hypogastric nerve-removing operation, while after hypogastric nerve-preserving operation those were 16.2 and 77.4%, respectively. There were no statistically significant differences in local recurrence, distant metastasis and survival between the two groups. CONCLUSIONS: Hypogastric nerve-preserving operation does not appear to carry an increased risk of local recurrence compared with hypogastric nerve-removing operation after an equivalent follow-up period.
Adult↗
Metastasis of rectal cancer to lymph nodes and tissues around the autonomic nerves spared for urinary and sexual function.
PURPOSE: To clarify the indications for autonomic nerve-sparing operations for rectal cancer, the presence of lymph nodes and metastasis in the tissue around the autonomic nerve were examined in 28 rectal cancer patients. These were staged as pT2 in 8 patients, pT3 in 19 patients, and pT4 in 1 patient histopathologically. METHODS: The specimens of the autonomic nerve including the inferior mesenteric plexus, preaortic plexus, superior hypogastric plexus, hypogastric nerve, and pelvic plexus were removed with radical abdominopelvic lymphadenectomy after the autonomic nerve-sparing rectal cancer operation. RESULTS: In the tissue around the autonomic nerve, lymph nodes were 11.2 +/- 9.6 in number and 2.6 +/- 2.4 mm in size (mean +/- standard deviation). The frequency of presence of lymph nodes was higher and the number of lymph nodes was larger in the inferior mesenteric plexus (70.4 percent; 3.6) and the preaortic plexus (66.7 percent; 2.1) than in the left and right pelvic plexuses (39.1 percent, 1; 36 percent, 1). Metastasis to the lymph nodes or lymphatic permeation in the tissue around the autonomic nerve were observed in four cases (14.3 percent) of lower rectal cancer, consisting of three with Stage III cancer (pT3, pN1-3, and M0) and one with Stage IV cancer (pT4, pN1, and pM1 (HEP)). CONCLUSION: Radical rectal excision that includes lymph nodes and adjacent tissue around the autonomic nerves may result in metastatic tumor removal that would otherwise be left in situ with nerve-sparing techniques for advanced rectal cancer in Stage III.
Autonomic Pathways↗
The female inferior hypogastric (= pelvic) plexus: anatomical and radiological description of the plexus and its afferences--applications to pelvic surgery.
AIM OF THE STUDY: We wanted to determine the anatomical features of the inferior hypogastric plexus (IHP), and the useful landmarks for a safe surgical approach during pelvic surgery. MATERIALS AND METHODS: We dissected the IHP in 22 formolized female anatomical subjects, none of which bore any stigmata of subumbilical surgery. RESULTS: The inferior hypogastric plexus (IHP) is a triangle with a posterior base and an anterior inferior top. It can be described as having three edges and three angles; its inferior edge stretches constantly from the fourth sacral root to the ureter's point of entry into the posterior layer of the broad ligament; its cranial edge is strictly parallel to the posterior edge of the hypogastric artery, along which it runs at a distance of 10 mm; its posterior (dorsal) edge is at the point of contact with the sacral roots, from which it receives its afferences. They most frequently originate from S3 or S4 (60%) and then, in one or two branches, often from S2 (40%), never from S1 and in exceptional cases from S5 (20%). There are sympathetic afferences in 30% of cases, usually through a single branch of the second, third or fourth sacral ganglion. All IHPs have at least one sacral afference and sometimes there may be up to three afferences from the same sacral root. Its dorsal cranial angle, which is superior, comes after the SHP (hypogastric nerve or presacral nerve filament); its anterior inferior angle is located exactly at the ureter's point of entry into the posterior layer of the broad ligament. This is the top of the IHP; its posterior inferior angle is located at the point of contact with the fourth sacral root. At its entrance at the base of the parametrium the pelvic ureter is the anterior, fundamental positional reference for the IHP. The vaginal efferences come out of the top of the IHP through branches leading to the bladder, the vagina and the rectum, which originate through two trunks exactly underneath the crossing point of the ureter and the uterine artery: (i) one trunk leading to the bladder runs along and underneath the ureter and divides into two groups, which are lateral and medial, trigonal. (ii) the trunk leading to the vagina runs along the inferior edge of the uterine artery. At the point of contact with the lateral edge of the vagina, it splits into two groups: anterior thin and posterior voluminous. Some of its branches perforate the posterior wall of the vagina and are distributed to the rectovaginal septum in a tooth comb pattern. The inferior branches, which emerge from the inferior edge of the IHP, reach the rectum directly. The dissection of the 22 specimens allowed us to describe three efferent plexuses: a vaginal rectal plexus, a vesical plexus and a inferior rectal plexus. So the IHP's anterior, fundamental positional reference is the pelvic ureter at the point where it enters at the base of the parametrium, then at the crossing point of the uterine artery. The ureter is the vector for vesical efferences, the uterine artery is the vector for vaginal efferences, which are thus sent into the vesicovaginal septum and the rectovaginal septum. This surgical point of reference is of vital importance in nerve sparing during the course of a simple or extended hysterectomy. Any dissection carried out underneath and outside of the ureter inevitably carries a risk of lesions to its efferent, lateral vesical or medial, rectovaginal fibres.
Afferent Pathways↗
Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain.
BACKGROUND: Patients with pain caused by cancer frequently experience visceral pain. In addition to oral pharmacologic therapy to manage pain, neurolytic blocks of the sympathetic axis are also effective in controlling visceral cancer pain. METHODS: Four types of neurolytic blocks (interpleural phenol, celiac plexus, superior hypogastric plexus, and ganglion impar) used in the treatment of visceral cancer pain are reviewed. RESULTS: Several studies have documented the efficacy of neurolytic blocks in reducing pain intensity and opioid consumption. However, the narrow risk-benefit ratio associated with neurolysis techniques requires knowledge of the implications associated with the different neurolytic blocks to minimize undesirable effects. CONCLUSIONS: Neurolysis of the sympathetic axis has been shown to be an effective and safe approach to treat visceral pain in cancer patients and should be incorporated in the armamentarium of the pain specialist as a useful adjunct to oral pharmacologic therapy.
Autonomic Nerve Block↗
Laparoscopic presacral neurectomy utilizing contact-tip Nd: YAG laser.
The performance of the presacral neurectomy with a standard laparoscopic approach utilizing a Contact-tip Nd: YAG Laser with the GRP6 sapphire scalpel tip is feasible, effective, and safe. Patients suffering from severe disabling dysmenorrhea have had complete relief of their symptoms with up to an eighteen-month follow up. The resection of the presacral nerve plexus is associated with significant relief of symptoms. The pain impulses from the uterus which travel through the inferior hypogastric plexus into the intermediate hypogastric plexus and the superior hypogastric plexus can be interrupted by the performance of this procedure in a laparoscopic manner. The intermediate hypogastric plexus which is composed of two or three trunks lying on the vertebral body of L5 is the most appropriate place for the resection. The presacral neurectomy is not appropriate treatment for relief of lateral or back pain. Patients with midline pain will experience significant relief by the use of this procedure. In conclusion, the performance of the presacral neurectomy utilizing the Contact-tip Nd: YAG Laser with GRP6 sapphire tip combined with other conservative surgery for resection of endometriosis does offer relief of dysmenorrhea and other pelvic pain and is an alternative for women wishing further childbearing and those who do not wish a hysterectomy. Twenty women in whom this procedure has been performed have reported a decrease in pain level from 9.4 (scale of 0 = no pain to 10 = disabling pain) to 2.0 with follow up to 18 months. There have been no complications with this procedure.
Dysmenorrhea↗
Complications during anterior surgery of the lumbar spine: an anatomically based study and review.
Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Critical structures at risk in the abdomen and retroperitoneum were identified, and their anatomical relationships were categorized and photographed. These structures included the psoas muscle, kidneys, ureters, diaphragm and crura, esophageal hiatus, thoracic duct, greater splanchnic nerves, phrenic nerves, sympathetic chains, medial arcuate ligament, superior and inferior hypogastric plexus, segmental and radicular vertebral vessels, aorta, vena cava, median sacral artery, common iliac vessels, iliolumbar veins, lumbosacral plexus, and presacral hypogastric plexus. Based on these dissections and an extensive review of the literature, the authors provide a detailed anatomically based discussion of the complications associated with anterior lumbar surgery.
Journal Article↗
[Nerve-sparing cystectomy technique in the woman].
With the advent of the nerve-sparing and urethral-support-sparing cystectomy technique, the urethral closure mechanism and the rhabdosphincter muscle of the lower urethra are left intact. The fibers of the interior hypogastric plexus supporting the urethra and the vagina remain intact. The autonomic nerve fibers are particularly at risk at two points: where they cross under the ureters between the uterine and vaginal arteries and in the bladder neck area. In both areas damage must bei avoided by careful dissection. The endopelvic fascia is incised immediately lateral to the posterior urethra at the urethrovesical junction. As much as possible of the urethropelvic ligament and the paraurethral vascular and nerve plexus must be saved. The urethrovesical junction is dissected off the anterior vaginal wall down to the posterior bladder wall. The cardinal ligaments are divided well anterior to avoid the pelvic plexus. The superior vesical artery and uterine vessels are cross-clamped, cut and tied. Once the uterine artery is transsected, the distal ureter comes into view and can be isolated, avoiding damage to the nerve fibers. The vaginal cavity is entered by a transverse incision, and the edges of the vaginal incision are held open with Ellis clamps. The distal stump of the ureter following its division is pulled medially to facilitate dissection of the lateral bladder wall. The perivesical vascular plexus and the inferior hypogastric plexus, which is located laterally to the vessels, are separated from the lateral wall of the bladder and vagina. (ABSTRACT TRUNCATED AT 250 WORDS)
Autonomic Nervous System↗
The extrinsic innervation of the pelvic organs in the female rat.
The extrinsic innervation of the pelvic organs in neonatal and adult female rats is described. Mainly an in toto acetylcholinesterase method is used; moreover, acetylcholinesterase is demonstrated in sections. The hypogastric plexus is defined as the nerve plexuses caudal to the inferior mesenteric ganglia comprising the uterine cervical ganglia and various smaller ganglia. The origin of the hypogastric plexus is formed by the hypogastric nerves, bundles of nerve fibers from the lumbar and cranial part of the sacral sympathetic trunks, bundles of nerve fibers from the inferior mesenteric ganglia and the pelvic nerves. The origin of the caudal part of the hypogastric plexus is also constituted by the pudendal nerves. The uterine nerves are derived from the ovarian nerves, the uterine cervical ganglia, the hypogastric nerves and the lumbar sympathetic trunks. The nerves to the urinary bladder are derived from the ganglionated nerve plexuses in the mesometrium as well as from the uterine cervical ganglia. The vaginal nerves are derived from the uterine cervical ganglia, the ganglionated nerve plexus in the mesometrium and the pudendal nerve. The rectal nerves are derived from the ganglionated inferior mesenteric plexus, the uterine cervical ganglia and the pudendal nerves. The hypogastric plexus in the rat is in many respects more complex than is known from the literature. These anatomical data are relevant for instance to experimentators who use the pelvic autonomic plexuses in the rat as a model system for the analysis of autonomic neuronal regulation systems in mammals.
Animals↗
Does perifascial rectal excision (i.e. TME) when combined with the autonomic nerve-sparing technique interfere with operative radicality?
OBJECTIVE: The lymphatic drainage from the rectum was studied to evaluate if the autonomic nerve sparing dissection may interfere with the operative radicality and might result in metastatic lymph nodes being overlooked and left in situ. PATIENTS AND METHODS: 50 consecutive patients had an extended extrafascial rectal excision resection for cancer. In 19 of the 50 patients activated carbon particles (CH40) were injected preoperatively into the rectum. The autonomic nerves with surrounding connective tissue were serially dissected from the resected specimen, carefully sliced at 5-mm intervals and collected for histological study. Lymph nodes along the axial and lateral drainage routes were examined, and the inclusion of CH40 in the nodes was microscopically studied according to the site of CH40 injection. RESULTS: Lymph nodes within the connective tissue along the dissected autonomic nerves were demonstrated in 47 of the 50 cases. Two of 50 cases had positive nodes along preaortic plexus or pelvic plexus, and a case with nodal involvement along the pelvic plexus had poor prognosis in spite of nerve excision. CH40 when injected into the rectum above the peritoneal reflection was demonstrated in the vast majority of the axial nodes, while in only one lymph node along the preaortic plexus when injected in the rectum above the peritoneal reflection. On the other hand when injected in the rectum below the peritoneal reflection, CH40 was demonstrated both in axial and lateral nodes as well as in lymph nodes along bilateral pelvic plexuses, right hypogastric nerve, superior hypogastric plexus, preaortic plexus and mesenteric plexus as well. CONCLUSIONS: When located above the peritoneal reflection a rectal carcinoma will spread preferentially along the upper axial route, while a carcinoma located below the peritoneal reflection will also spread laterally and along the autonomic nerves. It was inferred that lymphatic flow along the autonomic nerves came up from the rectum below the peritoneal reflection mainly through a so-called lateral ligament but its clinical significance was negligible. Therefore doing TME with autonomic nerve preservation does not imply a less radical surgery from the point of lymphatic spread.
Journal Article↗
Anesthetic pain management in Siriraj Hospital: a retrospective review.
Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. They consisted of 317 male and 329 female. The techniques included stellate ganglion block, paravertebral nerve block, celiac plexus block, hypogastric plexus block, mesenteric plexus block, sacral nerve block, epidural steroid, lumbar sympathectomy, first and second thoracic sympatholysis, facet joints injection, sacroiliac joint injection, intravenous regional block with guanethidine or ketanserin, continuous opioid infusion, intravenous lidocaine infusion, and a phentolamine test. The common problems of pain included brachial plexus injury, chronic spinal pain, herpetic neuralgia, ischemic pain, central post-stroke pain, and causalgia. This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.
Female↗
[Neuroanatomical study of micturition].
There are three superimposed centres of micturition: the sacral spinal centre, which is the oldest centre controlled by the pontine centre situated in the brain stem, which in turn is under the control of multiple subconscious structures: cerebellum, striate nucleus, hypothalamus and conscious structures: limbic cortex, frontal ascending and parietal ascending circumduction. The nervous pathways consist of the classical spinal pathways as far as their point of emergence. The innervation involves 2 systems:--a supra-levator system consisting of the essentially sympathetic superior hypogastric plexus and the essentially parasympathetic inferior hypogastric plexus which innervates the seminal tract, the bladder and the prostatic urethra;--a infra-levator system consisting of the internal pudendal nerve which innervates the striated sphincter.
Humans↗
Sympathetic innervation of guinea pig uterus and ovary.
The relative contribution of the ovarian nerves and hypogastric plexus in the innervation of the guinea pig uterus and ovary was assessed. Chronic section of the hypogastric nerve did not reduce norepinephrine (NE) concentration in either organ. Localization of the hypogastric plexus in female guinea pigs was unsuccessful. Crushing the ovarian nerves 1) lowered the NE concentration in the ovary (70%) and in all portions of the uterus (86%), 2) decreased by 80-90% the uterine retention of [3H]NE, and 3) decreased the intensity of fluorescent adrenergic fibers in the uterus. However, the denervated uterus failed to exhibit supersensitivity to NE. In conclusion, sympathetic innervation of the guinea pig uterus and ovary is predominantly via the ovarian nerves, and a minor pathway of innervation may come from hypogastric plexus.
Animals↗
Topography of the pelvic autonomic nerves in human fetuses between 21-29 weeks of gestation.
A topographical study concerning the autonomic nerves in the pelvis of human fetuses was performed by investigating 300-600 microns 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.
Autonomic Nervous System↗
Nerve-preserving aortoiliac reconstruction surgery: anatomical study and surgical approach.
OBJECTIVE: Dysfunctional ejaculation and, to a lesser extent, dysfunctional erection caused by disruption of efferent sympathetic pathways is a common complication after aortoiliac reconstruction surgery. The aim was to give an anatomic motivation for a nerve-preserving approach on the basis of right-sided unilateral disruption of lumbar splanchnic nerves. METHODS: Anatomic and microscopic analysis of preaortic and para-aortic retroperitoneal regions in human cadavers was performed. Anatomic analysis was conducted of two aortoiliac reconstruction operations performed on human cadavers; one was performed according to a single-blind procedure, the second with a modified procedure. RESULTS: The lumbar splanchnic nerves supplying the superior hypogastric plexus from the right side were found to be less voluminous than the left-sided ones. The superior hypogastric plexus was found slightly shifted to the left of the midsagittal plane across the abdominal aorta and its bifurcation. Microscopic analysis revealed a thin fascia between the aorta and the subperitoneal tissue compartment. This fascia was used as a plain of dissection to mobilize the preaortic nerve-plexuses without damage from the aortic wall. Analysis of the specimens operated on showed a significant difference in nerve disruption. The standard procedure caused total disruption of the superior hypogastric plexus and extensive disruption of the inferior mesenteric plexus. The modified procedure only caused right-sided unilateral disruption of lumbar splanchnic nerves. CONCLUSION: The autonomic nerves supplying the bladder neck, the vas deferens, and the prostate are closely related to the abdominal aorta and its bifurcation. Right-sided unilateral disruption of lumbar splanchnic nerves without further damage to nervous structures would ensure at least one functional sympathetic pathway remaining after aortoiliac reconstruction surgery.
Aorta, Abdominal↗