Complications of Orchiopexy
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
The ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve are the nerves of concern during orchiopexy. Both the ilioinguinal nerve and the iliohypogastric nerves arise from T12 and L1, and are responsible for sensation to the upper and medial aspects of the thigh and the skin of the base of the penis as well as the anterior portion of the thigh. The ilioinguinal nerve is typically found on the lateral aspect of the spermatic cord. It passes through the superficial inguinal ring to reach the subcutaneous tissues and the skin. The iliohypogastric nerve lies on the internal oblique abdominal muscle and penetrates the aponeurosis of the external oblique muscle near the rectus muscle to reach the subcutaneous tissue and the skin. The genital nerve has both motor and sensory components and innervates the cremaster muscle and the skin of the side of the scrotum. In the inguinal canal it lies on the iliopubic tract and is accompanied by the cremasteric vessels to form a neurovascular bundle that passes through the superficial inguinal ring.
Blocks of Nerves of the Trunk
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand in Pediatric Regional Anesthesia, 2019
The ilioinguinal nerve, which is usually smaller than the iliohypogastric nerve, is a branch of the first lumbar spinal nerve issuing just below the previous nerve, and its course is similar to that of the iliohypogastric nerve. It crosses the quadratus lumborum and the iliacus muscle obliquely, pierces the transversus abdominis (at the level of the iliac crest) and the oblique muscles, then reaches the lower border of either the spermatic cord (in the male) or the round ligament of the uterus (in the female), in the inguinal canal (Figure 4.14). It contributes fibers to (1) the internal oblique muscle, (2) the skin of the upper medial part of the thigh, and (3) either the skin of the upper part of the scrotum and the root of the penis or the skin covering the labium majus and the mons pubis.
The Conception Vessel (CV)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Ilioinguinal nerve (L1, occasionally with T12): Branches from the ilioinguinal nerve supply the skin of the scrotum and labium majus by means of its anterior scrotal and labial branches, respectively. Other branches supply the skin over the proximal and medial thigh. The ilioinguinal nerve accompanies the spermatic cord or round ligament of the uterus as it moves through the superficial inguinal ring, on the way to its destination of either the scrotum or labium majus, depending on the gender of the individual. The ilioinguinal nerve is involved in the afferent limb of the cremasteric reflex, along with the genitofemoral nerve (L1, L2). Branches of the ilioinguinal nerve include the anterior scrotal in males and the labial in females. Damage to the ilioinguinal nerve has been called an “infamous complication of inguinal hernia surgery.”16
Postoperative pain and neuropathy after caesarean operation featuring blunt or sharp opening of the fascia: a randomised, parallel group, double-blind study
Published in Journal of Obstetrics and Gynaecology, 2018
Fatma Yazici Yilmaz, Begum Aydogan Mathyk, Serhat Yildiz, Nefise Nazli Yenigul, Ceren Saglam
Not only the VAS scores, but also the incidence of neuropathy, were significantly higher in the sharp group at 1 and 3 months after surgery (p = .043 and p = .016, respectively) (Table 3). Neuropathic pain can be present immediately postoperatively or even weeks to months later; the classical manifestation is a burning pain in the lower abdomen (Cardosi et al. 2002; Whiteside et al. 2003; Rahn et al. 2010). Neuropathy is defined as the loss of sensation, paraesthesia and/or dysesthesia in the known region of distribution of a sensory nerve and/or as weakness in a muscle group supplied by a peripheral nerve. The iliohypogastric nerve supplies sensations to the skin of the glutaeal and hypogastric regions. The ilioinguinal nerve provides sensory innervation to the skin overlying the groyne, inner thigh and labia majora (Stulz and Pfeiffer 1982; Hahn 1989; Whiteside et al. 2003). In this study, the extent of neuropathy was lower in the blunt group than in the sharp group. The patients who developed neuropathy complained particularly about the numbness and hypoaesthesia in the region of the incision.
Non-pharmacological treatments for chronic orchialgia: A systemic review
Published in Arab Journal of Urology, 2021
Kareim Khalafalla, Mohamed Arafa, Haitham Elbardisi, Ahmad Majzoub
The present review identified 19 individual studies including 1676 testicular units for which MSCD was performed. In most cases an open approach for surgery was performed (inguinal [n = 14]; subinguinal [n = 3]; Table 1) [9–27]. Depending on the level of the incision, the aponeurosis of the external oblique muscle is either spared or opened. The ilioinguinal nerve is identified and a 2 cm segment is excised and ligated with proximal part buried well to avoid neuroma formation. Under microscopic magnification, the spermatic cord is brought up and its fascia is opened to expose the cord contents. Micro-Doppler ultrasonography (US) is used to identify the arterial flow in attempt to preserve testicular and cremasteric arteries during the procedure. The contents of the cord are ligated and dissected, which includes the cremasteric fascia, spermatic cord fat, and the pampiniform plexus of veins. Lymphatics are preferably spared to avoid hydrocele formation. The vas deferens is also preserved to reduce epididymal congestion, which decreases the incidence of post-vasectomy pain syndrome (PVPS). However, stripping of the perivasal tissues is performed to ensure obliteration of all the neural fibres.
Penile reconstruction: An up-to-date review of the literature
Published in Arab Journal of Urology, 2021
Nicholas Ottaiano, Joshua Pincus, Jacob Tannenbaum, Omar Dawood, Omer Raheem
A RFFF is a viable surgical option for penile reconstruction due to the predictable anatomy of the flap, pliable skin, and well-developed vessels [37] (Figure 5). The RFFF is harvested from the forearm and shaped to the phallus using the tube-within-a-tube technique wherein two skin paddles are rolled in opposing directions with a dermal vascular supply between the layers to supply the urethral skin paddle. An additional skin flap is then used to create a corona to mimic a circumcised glans. After anastomosing the urethra, the free flap is moved into place on the pubic area for the radial artery to be connected in an end-to-side fashion to the common femoral artery via microsurgical technique. The anastomosis of the venous drainage is also made microsurgically between the greater saphenous vein and the cephalic vein. Additionally, a cutaneous nerve, often the medial cutaneous nerve of the forearm, is connected to the ilioinguinal nerve to maintain protective sensation, while the dorsal penile nerve is connected to another nerve to achieve erogenous sensation [38].
Related Knowledge Centers
- Iliac Crest
- Iliacus Muscle
- Iliohypogastric Nerve
- Lumbar Nerves
- Psoas Major Muscle
- Quadratus Lumborum Muscle
- Spermatic Cord
- Transverse Abdominal Muscle
- Abdominal Internal Oblique Muscle
- Round Ligament of Uterus