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Robotic Rectal Cancer Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
SP Somashekhar, K Rajagopal Ashwin
The autonomic nerves consist of the paired sympathetic hypogastric nerve, sacral splanchnic nerves, and the pelvic autonomic nerve plexus. The superior hypogastric plexus is located ventrally to the abdominal aorta a t the origin of IMA and later bifurcates to form right and left hypogastric nerves just proximal to at the sacral hollow. The hypogastric nerves, which derive from the superior hypogastric plexus, carry the sympathetic signals to the internal urethral and anal sphincters, as well as to the pelvic visceral proprioception. The pelvic splanchnic nerves from S2 to S4 carry nociceptive and parasympathetic signals to the bladder, rectum, and colon. The hypogastric and pelvic splanchnic nerves merge into the pararectal fossae to form the inferior hypogastric plexus [16].
Peripheral Neuropathies of the Lower Urinary Tract Following Pelvic Surgery and Radiation Therapy
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
The opposing sympathetic innervation is from the hypogastric nerve. This nerve originates from the thoracolumbar segments T10-L2 after synapsing at the paravertebral sympathetic chains. The postsynaptic neurons then form the superior hypogastric plexus at the bifurcation of the aorta. The hypogastric nerves then travel 2 cm from the ureters and common iliac arteries,3 to the inferior hypogastric plexus, then to its target organs. Sympathetic branches then release noradrenaline causing detrusor relaxation via β-adrenergic inhibition and internal urethral sphincter excitation via α-adrenergic receptors, in addition to rectal, prostatic, and sexual functions.
Specific Synonyms
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Hypogastric nerve (W&G, p. 412 [Fig. 9–6], 413) Inferior hypogastric ganglia (A&V, p. 408 [Fig. 26–6])Inferior hypogastric plexus (W&W, p. 1135)Pelvic plexus-1 (ibid.)See, however, D: Hypogastric plexus. See, also, SS: Hypogastric plexus.
Topography of the pelvic autonomic nerves – an anatomical study to facilitate nerve-preserving total mesorectal excision
Published in Acta Chirurgica Belgica, 2022
Jan Gaessler, Friedrich Anderhuber, Sabine Kuchling, Ulrike Pilsl
Its parasympathetic afferences reach the plexus via the PSN. Zhang et al. [12] located the PSN underneath the presacral fascia. Hypogastric nerves and the sacral sympathetic trunks provide sympathetic input to the plexus [26,29]. Kirkham et al. [29] qualified the latter ones' contributions as 'less significant' by comparison with the hypogastric nerves. At the level of the sacral promontory, the hypogastric nerves are usually seen roughly 10 mm lateral to the midline [18]. Following their entry into the lesser pelvis, the hypogastric nerves run parallel to the 20 mm laterally located ureters [10,12]. In the majority of examined bodies, the hypogastric nerves appeared as networks of fine filaments instead of distinct nerves. Lin et al. [10] and Kirkham et al. [29] have made similar observations. Our results matched the observation of Bissett et al. [24] that the hypogastric nerves are confined to the presacral space and, thus, do not enter the 'holy plane'. In contrast, other studies found the hypogastric nerves in front of the presacral fascia and closely attached to the MRF [10,29]. We agree with Bisset et al. [24] who postulated that the existence of 'multiple layers in the parietal fascia with the presence of intervening loose areolar tissue' could pose the reason for such misconceptions. Dissection outside the hypogastric nerves in a separate layer of PPF would thereby be possible, and explain for the nerves' erroneous localisation in relation to the presacral fascia.
Electrical stimulation on urinary symptoms following stroke: a systematic review
Published in European Journal of Physiotherapy, 2019
Sara Kjaer Bastholm, Lena Aadal, Camilla Biering Lundquist
The ES intervention protocols differed according to the location of electrical current application, frequency (10–75 Hz), and the duration and intensity of treatment. All included studies, despite using different ES modalities aimed to decrease stroke-induced bladder hyperreflexia hence incontinence, by use of ES targeting the sacral nerve plexus. The mechanism of ES, though not fully understood, is considered a reflex inhibition of detrusor contraction by the activation of afferent fibres within the prudential nerve eliciting three actions of effect: 1. activation of the hypogastric nerve, 2. direct inhibition of the pelvic nerve within the sacral chord, and 3. supraspinal inhibition of the detrusor reflex [44–47]. Currently no consensus regarding optimal ES treatment for urge urinary incontinence and bladder hyperreflexia exist. A wide range of frequencies, intensities, durations of treatments and number of sessions have been reported in the literature [47]. Liu et al. [32] suggested that TENS with a frequency of 20 Hz is superior to 75 Hz. This is in agreement with a review from 2013 where electrical nerve stimulation with a frequency of 20 Hz was found effective in reducing urinary frequency and incontinence among adults with OAB of idiopathic origin [25].
A Modification of Laparoscopic Type C1 Hysterectomy to Reduce Postoperative Bladder Dysfunction: A Retrospective Study
Published in Journal of Investigative Surgery, 2019
Wei Jiang, Meirong Liang, Douxing Han, Hui Liu, Ling Li, Meiling Zhong, Lin Luo, Siyuan Zeng
Currently, there are two schools of thought regarding NSRHs: One of these favors a traditional approach, and the other favors a modified approach. The traditional school insists on the visualized preservation of the nerve by meticulous separation of the nerve, despite the prolonged and complicated nature of the procedure.6,7,12 To cope with the complex anatomy of the nerve plexus, numerous researchers have invented multiple instruments.6,7,12 In contrast, the modified approach spares the inferior hypogastric plexus as a whole without separating the autonomic nerve by direction of defined anatomical landmarks. The inferior hypogastric plexus is formed by the hypogastric nerve, pelvic splanchnic nerve, innervating bladder, uterus and rectum. A range of anatomical landmarks has been put forward to enable the preservation of the plexus. Fujii5 and Kato13 recommended separation of the inferior vesical vein to identify and preserve the bladder branch from the inferior hypogastric plexus, however, the preservation is difficult due to the rich anatomical variation. Ditto et al.14 and Bin Li et al.15 reported that the middle rectal artery demarcated the boundary between the nervous portion and vesicular portion of the CL. However, the middle rectal artery is subjected to rich anatomical variation and is more commonly single sided than double sided.16