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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 evaluation of lower urinary tract dysfunction in a patient at risk from peripheral neuropathy begins with a heightened level of suspicion by the provider. The inferior hypogastric plexus, in particular, is a complex network of both sympathetic and parasympathetic nerves, leading to unpredictable outcomes following peripheral nerve injuries in this region. The examination of these patients begins with a careful history of preprocedural urinary symptoms to differentiate between new and old symptoms. Symptom questionnaires are useful in obtaining a clear picture of current symptoms but are also a reliable way to measure changes in patient symptoms over time. Postoperatively, patients may present with clear urinary retention.
Anatomy & Embryology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
The autonomic nervous system provides sympathetic and parasympathetic supply to organs, blood vessels, glands and smooth muscle. The somatic system innervates skin, skeletal muscles and joints. Parasympathetic fibres arise from cranial and sacral spinal nerves, whilst sympathetic fibres for the thoracolumbar region originate from spinal nerves T1 to L3. The two sympathetic chains lie anteriorly on either side of the vertebral column to which the preganglionic fibres synapse. These fibres then continue via splanchnic nerves to the coeliac or superior and inferior plexuses associated with the aorta to synapse with postganglionic fibres that supply the target organ. Preganglionic fibres also directly supply the adrenal gland. The coeliac plexus is closely associated with the coeliac trunk and is where a significant proportion of the autonomic supply to the kidneys, adrenals, renal pelvis and ureters pass through. The superior hypogastric plexus lies below this near the aortic bifurcation and connects with the inferior hypogastric plexus below. Any disruption here during retroperitoneal lymph node dissection can result in retrograde ejaculation. The somatic lumbosacral plexus is formed from spinal nerves L1 to S3 and provides innervation to the abdomen and lower extremities. The major nerves of the plexus are described in the following table.
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
Anorectal dysfunction after radical cystectomy for bladder cancer
Published in Scandinavian Journal of Urology, 2022
Fredrik Liedberg, Oskar Hagberg, Gediminas Baseckas, Johan Brändstedt, Petter Kollberg, Anna-Karin Lind, Marie-Louise Lydrup, Annica Löfgren, Karin Stenzelius, Anne Sörenby, Marianne Starck
It is largely unknown if or how the extent of lymphadenectomy and nerve-sparing surgery during RC affect postoperative anorectal function related to possible injury of the superior and/or inferior hypogastric plexus [12], albeit nerve-sparing radical hysterectomy has been suggested to maintain anorectal function postoperatively [13]. On the other hand, a recent prospective assessment with Patient Assessment of Constipation Symptoms and Patient Assessment of Constipation Quality of Life questionnaires in patients subjected to RC, although reporting few constipation symptoms postoperatively, extended lymphadenectomy did not increase postoperative constipation symptoms compared to a more limited template [14].
Disruption of the network between Onuf’s nucleus and myenteric ganglia, and developing Hirschsprung-like disease following spinal subarachnoid haemorrhage: an experimental study
Published in International Journal of Neuroscience, 2019
Ozgur Caglar, Binali Firinci, Mehmet Dumlu Aydin, Erdem Karadeniz, Ali Ahiskalioglu, Sare Altas Sipal, Murat Yigiter, Ahmet Bedii Salman
According to the classic understanding of the autonomic innervation of human in the lower abdomen, parasympathetic ganglion cells are located near the pelvic viscera and in the pelvic plexus, whereas sympathetic ganglion cells exist along the lumbar and sacralsympathetic trunks [11]. Affection of these nerves lead to sexual and sphincter dysfunction in human [11]. This dysfunction seems to be dependent to damage to the hypogastric nervous plexus. The superior and inferior hypogastric plexuses receive input from sympathetic preganglionic fibres whose cell bodies reside in the intermediolateral cell columns of the lower spinal cord. Same mechanism may be responsible in Hirschprung Disease. The superior and inferior hypogastric plexuses receive input from sympathetic preganglionic fibres whose cell bodies reside in the intermediolateral cell columns of the lower spinal cord [12] or the sacral spinal cord. This cell group was first described in 1899 by Onufrowicz and became as known as Onuf's nucleus. These efferent, preganglionic fibres first leave the spinal cord via the ventral roots of spinal nerves and exit the spinal nerves via the white rami communicantes into the lumbosacral sympathetic chain [12]. Onuf’s nucleus is localized mainly in S3–4 segments. It is composed of organized medium-sized neurons and located in the ventrolateral aspect of the ventral horn of the first sacral segment. Onuf’s nucleus has different cortical afferent connections with contralateral corticospinal tract fibres [13] and contains motorneurons that innervate the pelvic floor muscles, including the external urethral and anal sphincters, and manage micturition, vomiting, defecation, and parturition reflexes [14].