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Urologic Involvement
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Jörg Keckstein, Gernot Hudelist, Simon Keckstein
The next step is ureteral resection with complete parametrectomy. This step serves not only to restore unobstructed urinary flow but also to completely resect the deep endometriosis on the pelvic wall, which can also cause severe pain. Identification and preservation of the parasympathetic pelvic splanchnic nerves and inferior hypogastric nerves can be challenging for the surgeon at the same time. Placement of a DJ ureteral stent may be helpful. After isolation and resection of the narrowed portion of the ureter, the surgical technique used depends on the distance to be closed. If the proximal ureteral segment had a limited length, direct reimplantation is performed. The proximal portion of the ureter should be mobilized sufficiently in the cranial direction. The urinary bladder, which is also well exposed, is fixed with psoas hitch sutures to the m. psoas to reduce tension at the anastomosis. In selected cases, when the residual length of the ureter is extremely short, cystoplasty may be performed to reduce the tension at the anastomosis. The bladder is opened transversely and laterally to the bladder dome. The attachment to the psoas muscle is done with three interrupted sutures, respecting the genitofemoral nerve branches. The ureter is passed through a submucosal tunnel into the bladder wall to avoid reflux.
Cauda Equina Syndrome
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
The bladder’s innervation is via the pelvic splanchnic nerves (S2–S4), with sensory input from the hypogastric, pelvic and pudendal nerves, while the autonomic control is primarily via the parasympathetic system. Stimulation of these nerves causes bladder emptying through stimulation of the detrusor muscle and inhibition of the urethral sphincter. Damage to these nerves results in bladder atony with urinary retention and the absence of voluntary control. Defecation is controlled by the internal (involuntary) and external (voluntary) anal sphincters. Stimulation of the rectum from stool triggers the pudendal nerve (S2–S4) to increase peristalsis and relax the sphincters.
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].
The neural pathway of the hyperthermic response to antagonists of the transient receptor potential vanilloid-1 channel
Published in Temperature, 2023
Andras Garami, Alexandre A. Steiner, Eszter Pakai, Samuel P. Wanner, M. Camila Almeida, Patrik Keringer, Daniela L. Oliveira, Kazuhiro Nakamura, Shaun F. Morrison, Andrej A. Romanovsky
Since bilateral transection of the greater splanchnic nerve did not block the hyperthermic response to AMG0347 (Experiment 3), we know that the spinally transmitted signals that drive TRPV1 antagonist-induced hyperthermia do not reach the spinal cord through the greater splanchnic. A priori, the lesser, least, lumbar, and pelvic splanchnic nerves may be involved, but all of them are much smaller than the greater splanchnic nerve and service the relatively small amount of tissue in various organs at the bottom of the abdominal cavity [9,10]. Furthermore, among the splanchnic nerves, both the level of TRPV1 expression and the percentage of capsaicin-sensitive fibers generally decrease in the caudal direction, from the greater nerve to the pelvic one [14].
Female genito-pelvic reflexes: an overview
Published in Sexual and Relationship Therapy, 2019
Symen K. Spoelstra, Esther R. Nijhuis, Willibrord C. M. Weijmar Schultz, Janniko R. Georgiadis
Pelvic viscera, including cavernous tissues, contain smooth muscle that is innervated by the autonomic nervous system. Sympathetic innervation derives from pregang.lionic motoneurons in the last three thoracic and the first two lumbar spinal cord segments. Post-ganglionic sympathetic fibres may reach the pelvic viscera either via the paired hypogastric nerve which originates from pre-aortic sympathetic ganglia or via branches originating from the sacral continuation of the sympathetic chain ganglia (Everaert et al., 2010). Thus, the former nerves descend into the pelvis while the latter reach the pelvis viscera from posteriorly. The parasympathetic pelvic splanchnic nerves arise from preganglionic motoneurons in the sacral segments to reach the pararectal pelvic parasympathetic ganglia (Everaert et al., 2010). The role of the parasympathetic vagal nerve in pelvic innervation is controversial. At the level of the pararectal parasympathetic ganglia, the sympathetic and parasympathetic nerve systems become entangled – and probably also interact – to form an inferior hypogastric plexus on both sides of the rectum. Visceral sensory information uses the neuroarchitecture laid out by the autonomic nerves to enter the spinal cord at corresponding levels. Most of vaginal sensory fibres travel in the parasympathetic pelvic splanchnic nerve (Everaert et al., 2010) or along with the sympathetic fibres arising from sacral sympathetic ganglia. However, the fact that paraplegic women may still perceive deep vaginocervical stimulation and may reach orgasm by virtue of this stimulation strongly suggests that a part of deep vaginal and cervical sensory information travels with the sympathetic hypogastric nerve (Sipski, Alexander, Gomez-Marin, Grossbard, & Rosen, 1996) or possibly even the parasympathetic vagal nerve (Komisaruk et al., 2004).
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
In addition to the paravesicalspace and pre-rectal space, three other vital spaces were developed: the paracervical space, located between the vesicocervical ligament and CL, pararectal space, and vesicovaginal space. Two-thirds of the ureteral mesentery was preserved. The parametrium was separated and divided at the plane of convergence of the cervical and bladder branches of the DUV, without the inclusion of the CL. The pelvic splanchnic nerve was left undetached in the plexus. The anatomy figures were shown in Figure 1.