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Results for “HYPOGASTRIC PLEXUS”

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At least 91 records · Page 5Linked to original sources
PubMed2001

The pelvic plexus and antireflux surgery: topographical findings and clinical consequences.

PURPOSE: Voiding dysfunction and urinary retention are rare complications of antireflux surgery. As mainly reported after bilateral antireflux surgery with extravesical technique, bladder insufficiency has been suspected to be caused by intraoperative damage to neural structures. We studied the topography of the pelvic plexus and assessed the injury to the plexus resulting from antireflux surgery. MATERIALS AND METHODS: Human cadavers fixed with Thiel solution were used for dissection. The superior hypogastric plexus and hypogastric nerves were identified as the pathway to the pelvic plexus. After dissecting the surrounding fatty tissue the S2 to S4 nerves and efferent nerve bundles from the pelvic plexus were identified. RESULTS: The main portion of the pelvic plexus was located about 1.5 cm. dorsal and medial to the ureterovesical junction. The bundles of the pelvic plexus ended at the distal ureter, trigone and rectum. When simulating an antireflux procedure, there was a high risk of injury to the pelvic plexus and its efferent nerves if dissection was performed distal to the ureter and dorsal trigone. CONCLUSIONS: Careful dissection close to the ureter avoids inadvertent injury to the pelvic plexus. To minimize the risk of voiding dysfunction bilateral antireflux surgery should be performed at 2 sessions unless the operative technique allows preservation of the neural structures.

Aged↗
PubMed1992

The long colic nerves in human fetuses. I. Macroscopic studies.

The long colic nerves were investigated in 50 fetuses aged 13 to 21 weeks. The long colic nerves arise from the pelvic nerves, pelvic plexuses, hypogastric nerves, and intermesenteric plexus. The nerves may take origin from two or three sources, and in most cases they arise from the pelvic nerves. They ascend along the sigmoid and descending colons reaching the left portion of the transverse colon.

Colon↗
PubMed2004

A simple technique for identification and preservation of the hypogastric nerves during rectal surgery.

HYPOTHESIS: Rectal resection is associated with a risk of sexual dysfunction even when performed for benign disease, with the most frequent type resulting in retrograde ejaculation due to injury to the hypogastric nerves. DESIGN: A simple technique to identify and protect these nerves during rectal mobilization. SETTING: Exposure of the hypogastric plexus during rectal resection. CONCLUSION: Careful identification of the hypogastric nerves during rectal mobilization using the described technique may reduce injury to these nerves and related sexual dysfunction.

Digestive System Surgical Procedures↗
PubMed2001

[Physiology of the urethral sphincteric vesico-prostatic complex].

We propose a review of the literature about innervation and physiology of the urethral sphincteric complex. Parasympathetic innervation of the pelvic viscera comes from ventral branches of the sacral nerves (S2-S4). The orthosympathetic component derives from superior hypogastric plexus and runs down the hypogastric nerves to form the right and left pelvic plexus together with the parasympathetic component. The pelvic plexus is situated inferolaterally with respect to the rectum and runs on the surface of the levator ani muscle down to the prostatic apex. The pelvic plexus gives innervation to the rectum, the bladder, the prostate and the urethral sphincteric complex. The pelvic muscular floor is innervated by the somatic component (pudendal nerve) derived from the sacral branches (S2-S4). Bladder neck and smooth muscle urethral sphincter innervation is given mostly by the orthosympathetic component. The rhabdosphincter innervation comes from the pudendal nerve and from the pelvic plexus; its role in the continence mechanism is probably to give steady tonic urethral compression. Levator ani muscle takes part in the sphincteric complex with its anteromedial pubococcygeal portion. It plays its role strengthening the sphincteric tone during increase of the abdominal pressure or during active quick stop cessation of the urinary stream.

Humans↗
PubMed1998

Neural blockade for abdominopelvic pain of oncologic origin.

Neural blockade, like other accepted treatments for persistent pain, is not a panacea. Careful assessment is required to elicit the need for complementary interventions, including pharmacological management and psychobehavioral and rehabilitative approaches, combined with attention to the palliation of other symptoms. Celiac and superior hypogastric plexus blocks are well-accepted, effective, and minimally hazardous means for providing palliation of visceral abdominopelvic pain. Although they require radiological imaging, they are relatively undemanding of the experienced anesthesiologist pain specialist and do not deplete patients' limited resources and energy. Because of their uniquely favorable risk:benefit ratio, these procedures should be considered early in the course of treating patients with abdominopelvic pain that is expected to persist.

Abdominal Pain↗
PubMed2004

Anatomy of the pelvic plexus and innervation of the prostate gland.

We have examined the anatomy of the pelvic (inferior hypogastric) plexus in six male cadavers, paying particular attention to gross anatomical landmarks that might aid in locating it and have used immunohistochemistry to study the small branches of the plexus that supply the prostate gland. The pelvic plexus was found two finger breadths lateral to the third anterior sacral foramina, lying deep to a line drawn from third sacral vertebra, the conventional level of the recto-sigmoid junction, and the palpable posterior superior surface of the pubic symphysis. Immunohistochemical staining showed small nerve branches from the pelvic plexus entering the prostate gland and the presence of ganglia within the prostate gland that contained both tyrosine hydroxylase positive and negative neuronal cell bodies. This information may be useful in nerve-sparing surgical procedures and in discussions of the functional implications of perturbations of prostate innervation.

Aged↗
PubMed1992

Ability of each lumbar splanchnic nerve and disability of thoracic ones to generate seminal emission in the dog.

Control of seminal emission by canine thoracolumbar splanchnic nerves which constitute the caudal mesenteric plexus (inferior mesenteric and superior hypogastric plexuses in human) was investigated. Electrical stimulation of a splanchnic nerve group which branched from sympathetic trunks at thoracic and L1 ganglia and descended on the ventral wall of the aorta between bilateral spermatic arteries via the intermesenteric plexus did not cause seminal emission in all 13 dogs examined. In contrast, electrical stimulation of the other splanchnic nerve group which branched from lumbar sympathetic trunks at ganglia L1-L5 and descended behind bilateral spermatic arteries induced seminal emission regardless of branching levels or sides. The results indicate that efferent signals via the intermesenteric plexus do not generate seminal emission, while those via each lumbar splanchnic nerve have ability to generate seminal emission in the dog.

Animals↗
PubMed1997

Coexpression of neuropeptide Y and vasoactive intestinal polypeptide in pelvic plexus neurones innervating the uterus and cervix in the rat.

The present study investigates the distribution and coexpression of neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP) in neurones of the accessory ganglion (AG), hypogastric plexus (HP) and paracervical ganglion (PCG), which compose the pelvic plexus in the female rat. Nerve cell bodies immunoreactive for NPY and VIP represent 84% and 46% of the neurone population in the PCG, respectively, while immunoreactivity for each peptide is observed in about 90% of the AG and HP neurones. Adjacent sections immunostained for NPY and VIP, as well as the use of immunocytochemistry combined with in situ hybridization show that 92% of the VIP-containing neurones in the pelvic plexus also contain NPY. In addition, a retrograde tracing study performed in combination with immunocytochemistry demonstrates that pelvic plexus neurones project preferentially to the lower part of the uterus and to the cervix, and that about 95% of these projecting neurones contain VIP. Taken together, our findings indicate that in the female rat, neurones of the pelvic plexus projecting to the lower genital tract mainly coexpress VIP and NPY, and supply nerve fibres to the vascular and nonvascular smooth muscle in the uterocervical region. Since NPY and VIP exert distinct effects according to the target tissue, our results suggest that neurones coexpressing these peptides play important roles in the local regulation of the vascular bed and motor activity of the lower genital tract.

Animals↗
PubMed2004

The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain.

Neurolytic sympathetic plexus block (NSPB) has been proposed to prevent the development of pain and improve the quality of life of patients with cancer, thus questioning the WHO protocol that proposes the use of invasive methods only as a final resort. This study evaluates the pain relief, opioid consumption and quality of life provided by the use of NSPB in two different phases of cancer pain and compares them with that provided by pharmacological therapy only. Sixty patients with abdominal or pelvic cancer pain were divided into three groups and observed for 8 weeks. In group I, neurolytic celiac (NCPB) or superior hypogastric plexus block (SHPB), or lumbar sympathetic ganglion chain block (LSGCB) was performed with alcohol in patients using NSAID and a weak oral opioid or morphine (dose</=90 mg/day) and reporting VAS>/=4. In group II, NCPB, SHPB or LSGCB were performed on patients using NSAID and morphine (dose>/=90 mg/day) and reporting VAS>/=4. The patients of group III received pharmacological therapy only. The patients of groups I and II had a significant reduction of pain (P < 0.004), opioid consumption (P < 0.02) and a better quality of life (P < 0.006) than those of group III, but no significant differences between groups I and II were seen in these aspects. Opioid-related adverse effects were significantly greater in group III (P < 0.05). The occasional neurolysis-related complications were transitory. The results suggest NSPB for the management of cancer pain should be considered earlier in the disease.

Abdominal Neoplasms↗
PubMed1993

Laparoscopic implantation of electrodes for stimulation of the hypogastric nerve and the vas deferens in dogs.

The minimal invasiveness of laparoscopy prompted us to investigate its use for placement of electrodes for stimulation of the hypogastric nerve and the vas deferens. In an acute canine model, pressure changes in the vas deferens secondary to electrostimulation were recorded. The laparoscopic approach included four ports. Monopolar cuff electrodes were placed around the hypogastric nerve and the vas deferens, and the leads of both were pulled through the abdominal wall. After multiple percutaneous stimulations (20 mAmp., 20 Hz. and 200 microsecond pulse width), the abdomen was opened through a midline incision to check the position of the electrodes. Electrostimulation was repeated with the abdomen open. Electrostimulation of both the hypogastric nerve and vas deferens resulted in marked pressure rises in the vas. These increases were similar in response to both surface and percutaneous stimulation. We thus believe that laparoscopic implantation of electrodes followed by percutaneous preliminary stimulation of the superior hypogastric plexus or the vas deferens may be a viable future approach to anejaculation.

Animals↗
PubMedDate not supplied

Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain.

OBJECTIVE: The classic posterior approach of superior hypogastric block has several technical difficulties. The transdiscal approach is a novel and easier approach for superior hypogastric which overcome these technical difficulties. METHODS: Thirty patients were randomly allocated to two groups: The transdiscal group and the classic group; visual analog scale pain scores, daily morphine consumption, duration of the procedure and side effects were recorded. RESULTS: The duration of the procedure was significantly decreased in the transdiscal group (24.4+/-5.6 min) compared to the classic group (57.9+/-9.8 min). There were no significant differences between the 2 groups in daily morphine consumption and VAS pain scores. There was no discitis, disc rupture, or herniation in the transdiscal group. CONCLUSION: The transdiscal approach for superior hypogastric plexus block in pelvic cancer pain is easier, safer, and more effective with less side effects than the classic approach.

Aged↗
PubMed2000

Anatomic basis for the continence-preserving radical retropubic prostatectomy.

The technique of continence-preserving anatomic radical retropubic prostatectomy focuses on the preservation of the following anatomic components of the external striated urethral sphincteric complex: (1) the entire circumference of the rhabdosphincter musculature, (2) the periurethral fascial investments (the pubourethral ligaments anterolaterally and median fibrous raphe posteriorly), and (3) the innervation of both the rhabdosphincter by way of the intrapelvic branch of the pudendal nerve (somatic) and the mucosal and smooth muscle components by way of the urethral branch of the inferior hypogastric plexus (autonomic). The clinical impact of preserving the external striated urethral sphincter and its innervation by performing a continence preserving anatomic retropubic prostatectomy is a shorter time to achieve urinary continence.

Fascia↗
PubMed2001

A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix.

INTRODUCTION: Cancer pain in the terminally ill often poses great therapeutic dilemma. Opioids, whilst being useful in most cases, often leaves a patient heavily sedated and constipated at high doses and sometimes, in persistent agony from cancer pain. CLINICAL PICTURE: An Indian lady who suffered from metastatic carcinoma of the cervix experienced tremendous pain and disability despite high doses of narcotics and membrane stabilizers. TREATMENT: A ganglion of impar block and superior hypogastric plexus block were performed with a neurolytic agent. OUTCOME: The patient's pain and opioids usage were markedly reduced. CONCLUSION: Neurolytic nerve block can offer a great therapeutic option in selected cancer patients.

Adult↗
PubMedDate not supplied

[Nerve sparing total mesorectal excision for rectal cancer. Technical notes and results].

OBJECTIVE: To evaluate the quality of life after nerve sparing total mesorectal excision for rectal cancer. PATIENTS AND METHODS: Crucial technical aspects of the procedure such as the preservation of genitourinary innervation and the achievement of optimal local control of the disease have been emphasized. It is known that local recurrences, sexual and urinary dysfunctions may have a significant impact on postoperative quality of life of the patients. Postoperative evaluation of functional outcomes of nerve sparing total mesorectal excision has been carried out utilizing the QLQ C30 (version 3) (All CR38). RESULTS: At one year follow-up 27.2% of the patients presented sexual activity related dysfunctions, 6.1% complained of urinary dysfunction and 21% of the patients complained of some significant psychologic disturbances. CONCLUSIONS: A correct surgical dissection with preservation of inferior hypogastric plexus and all genitourinary nerve supply yield the best results either in terms of quality of life and of oncologic control of the disease.

Adult↗
PubMed2003

Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis.

Bladder, bowel, and sexual dysfunction caused by iatrogenic lesions of the inferior hypogastric plexus (IHP) are well known and commonly tolerated in pelvic surgery. Because the pelvic autonomic nerves are difficult to define and dissect in surgery, and their importance often ignored, we conducted a gross anatomic study of 90 adult and four fetal hemipelves. Using various non-surgical approaches, the anatomic relations and pathways of the IHP were dissected. The IHP extended from the sacrum to the genital organs at the level of the lower sacral vertebrae. It originated from three different sources: the hypogastric nerve, the sacral splanchnic nerves from the sacral sympathetic trunk (mostly the S2 ganglion), and the pelvic splanchnic nerves, which branched primarily from the third and fourth sacral ventral rami. These fibers converge to form a uniform nerve plate medial to the vascular layer and deep to the peritoneum. The posterior portion of the IHP supplied the rectum and the anterior portion of the urogenital organs; nerve fibers traveled directly from the IHP to the anterolateral wall of the rectum and to the inferolateral and posterolateral aspects of the urogenital organs. The autonomic supply from the IHP was supplemented by nerves accompanying the ureter and the arteries. An understanding of the location of the autonomic pelvic network, including important landmarks, should help prevent iatrogenic injury through the adoption of surgical techniques that reduce or prevent postoperative autonomic dysfunction.

Adult↗
PubMed1992

Potency, cure, and local control in the operative treatment of rectal cancer.

Impotence due to parasympathetic nerve injury is one of the most feared consequences of operations for treatment of rectal cancer. Sharp dissection along the parietal pelvic fascia where the parasympathetic nerves are located significantly reduces the incidence of pelvic failure. Autonomic nerve-preserving pelvic sidewall dissections, which combined the benefits of en bloc parietal pelvic dissection with nerve preservation, were performed in 42 men who were undergoing sphincter-preserving operations for treatment of rectal cancer. Thirty-three (86.7%) of the 38 evaluable patients have remained potent, and 29 (87.9%) of the 33 patients have normal ejaculation. Deliberate sacrifice of the inferior hypogastric plexus caused only minor sexual dysfunction. Cancer recurred locally in only one patient (with stage D cancer). Autonomic nerve-preserving pelvic sidewall dissection combines the benefits of curative resection and local control with reduced morbidity, and it preserves potency.

Adult↗
PubMed1988

Retroperitoneal lymphadenectomy for testis tumor with nerve sparing for ejaculation.

The principal morbidity of retroperitoneal lymphadenectomy is the potential loss of ejaculation and, therefore, fertility owing to damage of the retroperitoneal sympathetic nerves that form the superior hypogastric plexus. We describe the results of our retroperitoneal lymphadenectomy when individual nerves from the sympathetic ganglia are identified and preserved while still performing a thorough bilateral retroperitoneal lymphadenectomy. The nerve-sparing procedure was technically feasible in 20 of 30 consecutive patients and it was only impractical with extensive gross disease. Of the 20 patients 18 (90 per cent) ejaculate, including 8 with bulky (5 cm. or more) residual retroperitoneal disease who underwent a successful nerve-sparing operation. All 12 patients (100 per cent) with nonbulky disease ejaculate. With short followup, no retroperitoneal recurrences have been detected. This technique is an alternative to limited dissection designed to spare nerves using boundaries based on the patterns of metastatic involvement.

Ejaculation↗