Anatomy of the female pelvic nerves: a macroscopic study of the hypogastric plexus and their relations and variations.

Aurore, Valerie; Röthlisberger, Raphael; Boemke, Nane; Hlushchuk, Ruslan; Bangerter, Hannes; Bergmann, Mathias; Imboden, Sara; Mueller, Michael D.; Eppler, Elisabeth; Djonov, Valentin Georgiev (2020). Anatomy of the female pelvic nerves: a macroscopic study of the hypogastric plexus and their relations and variations. (In Press). Journal of anatomy Wiley-Blackwell 10.1111/joa.13206

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The autonomic nerves of the lesser pelvis are particularly prone to iatrogenic lesions due to their exposed position during manifold surgical interventions. Nevertheless, the cause of rectal and urinary incontinence or sexual dysfunctions, for example after rectal cancer resection or hysterectomy, remains largely understudied, particularly with regard to the female pelvic autonomic plexuses. This study focused on the macroscopic description of the superior hypogastric plexus, hypogastric nerves, inferior hypogastric plexus, the parasympathetic pelvic splanchnic nerves and the sympathetic fibres. Their arrangement is described in relation to commonly used surgical landmarks such as the sacral promontory, ureters, uterosacral ligaments, uterine and rectal blood vessels. Thirty-one embalmed female pelvises from 20 formalin-fixed and 11 Thiel-fixed cadavers were prepared. In all cases explored, the superior hypogastric plexus was situated anterior to the bifurcation of the abdominal aorta. In 60% of specimens, it reached the sacral promontory, whereas in 40% of specimens, it continued across the pelvic brim until S1. In about 25% of the subjects, we detected an accessory hypogastric nerve, which has not been systematically described so far. It originated medially from the inferior margin of the superior hypogastric plexus and continued medially into the presacral space. The existence of an accessory hypogastric nerve was confirmed during laparoscopy and by histological examination. The inferior hypogastric plexuses formed fan-shaped plexiform structures at the end of both hypogastric nerves, exactly at the junction of the ureter and the posterior wall of the uterine artery at the uterosacral ligament. In addition to the pelvic splanchnic nerves from S2-S4, which joined the inferior hypogastric plexus, 18% of the specimens in the present study revealed an additional pelvic splanchnic nerve originating from the S1 sacral root. In general, form, breadth and alignment of the autonomic nerves displayed large individual variations, which could also have a clinical impact on the postoperative function of the pelvic organs. The study serves as a basis for future investigations on the autonomic innervation of the female pelvic organs.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Anatomy
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology

UniBE Contributor:

Röthlisberger, Raphael; Boemke, Susanne; Hlushchuk, Ruslan; Bergmann, Mathias; Imboden, Sara; Mueller, Michael; Eppler, Elisabeth and Djonov, Valentin Georgiev

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0021-8782

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Jeannine Wiemann

Date Deposited:

24 Jun 2020 10:03

Last Modified:

25 Jun 2020 06:21

Publisher DOI:

10.1111/joa.13206

PubMed ID:

32427364

Uncontrolled Keywords:

accessory hypogastric nerve anatomical variation clinical anatomy female pelvis inferior hypogastric plexus pelvic splanchnic nerve superior hypogastric plexus sympathetic nerve fibres

BORIS DOI:

10.7892/boris.144426

URI:

https://boris.unibe.ch/id/eprint/144426

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