Nerves and major accessory ganglia of the pelvic plexus are described from 12 rats perfused with methylene blue. Nerves to ventral and dorsal aspects of the urinary bladder, and three groups of nerves to the penis (clitoris) are reported in detail.Myelinated nerve fiber diameters ranged from 1-10 P in the pelvic nerve and 1-6 EL in the hypogastric nerve. When the pelvic nerve was deaerentated, by spinal ganglionectomy 28 days previously, 80% of myelinated fibers degenerated, and the remaining fiber-size spectrum resembled that of the hypogastric nerve. Myelinated fibers ranged from 1-7 EL in nerves to bladder and 1-3 P in the lateral nerve to the penis. Myelinated fibers were afferent in these nerves, since spinal ganglionectomy eliminated all of them. In the main nerve to the penis, myelinated fibers ranged from 1-8 EL in diameter. A few fibers remained after deafferentation by spinal ganglionectomy. Since these were preganglionic efferent fibers, they indicate that terminal ganglia were present in the penis. All myelinated fibers degenerated with transection of pelvic and hypogastric nerves. The mode diameter of myelinated fibers was 2 EL in all pelvic plexus nerves.The role of pelvic ganglia in regulation of pelvic visceral activity is not well understood. One factor complicating the investigation of pelvic ganglia is the complexity of the pelvic plexus in most experimental animals. In most cases, the pelvic plexus is comprised of many widely dispersed ganglia with multiple interconnections. The pelvic plexus of the rat, however, has a single major ganglion with distinct sympathetic (hypogastric nerve) and parasympathetic (pelvic nerve) inputs and postganglionic nerves to the pelvic viscera (Langworthy, '65). This arrangement suggests the pelvic plexus of the rat as an ideal model for the investigation of ganglionic activity regulating pelvic viscera.Gross and microscopic structure should form a base for the interpretation of electrophysiologic data. Histochemical studies of the pelvic plexus have been reported for several species (Sjostrand, '65; Owman and Sjostrand, '65; El Badawi and Schenk, '66, '68, '70, '71a,b). However, fiber spectra of the nerves of the pelvic plexus of the rat has not been reported. The objectives of this paper are (1) to reinvestigate the gross morphology of the pelvic plexus of the rat with particular emphasis on the nerves to the bladder and penis (clitoris); (2) to report the fiber spectrum of the pelvic nerve, hypogastric nerve and nerves to the bladder and penis distal to the pelvic ganglion; and ( 3 ) to determine the presence of afferent fibers and/or preganglionic efferent fibers projecting through the ganglion to the pelvic viscera. METHODSPelvic ganglia and associated nerves were dissected using a Zeiss operating microscope in 12 male and female white rats Received Oct. 9 '72. Accepted Nov. 30, '72.

No abstract

No abstract

SutntnaryMedian nerve compression at the wrist (Carpal Tunnel Syndrome) is commonly associated with local trauma around the flexor retinaculum. Repeated manual activity also exacerbates the disease severity . We undertook a prospective study of the incidence of Carpal Tunnel Syndrome (CTS) in 47 paraplegic patients who have used their hands extensively for daily activity. Since surgical decompression generally provides excellent relief of symptoms, early detection of CTS will be particularly important in these patients. Of the 47 patients studied, 19 had clinical CTS (40%). A total of 91 hands (nerves) were tested with motor and sensory nerve conduction of the median and ulnar nerves. Electrophysiological evidence of CTS was noted in 57 hands (63%). The incidence of CTS appears to be related to the duration of Spinal Cord Injury. Concurrent ulnar neuropathy at the elbow was noted in 19 patients (40%). There was no predisposing factor such as diabetes mellitus in any of these patients, and the compressive neuropathy appears to be purely mechanical.

Bladder function was studied in 44 patients with bladder outlet obstruction by gas cystometry, integrated sphincter electromyography and uroflowmetry. Of these 44 patients 18 demonstrated detrusor hyperreflexia on cystometry. To identify the prostate as a possible source for triggering sensory stimuli pharmacologic ablation with lidocaine was performed through a perineal approach in 11 patients with hyperreflexia. Prostatic block eliminated hyperreflexia in 10 of 11 patients and had no effect in 4 patients with a normal cystometrogram. We believe that this study lends support to the concept that sensory stimuli from an anatomically altered prostatic urethra induces detrusor hyperreflexia. This suggests that permanent ablation of sensory stimuli from the prostate in patients with outlet obstruction would be of benefit.

Innervation to muscles of the feline perineum was examined by gross dissection of the sacral nerve plexus and quantitation of efferent and afferent myelinated fibers in selected nerves derived from the plexus. In addition, distribution of muscle fiber sizes and muscle spindle content were determined for muscles innervated by the nerves studied.Efferent myelinated fiber populations were bimodal in nerves innervating muscles with many spindles and unimodal in nerves innervating muscles in which few or no spindles were observed. Coccygeus and levator ani muscles had similar numbers of muscle spindles, but the spindles were different in the two muscles based on afferent innervation. In both coccygeous and external and sphincter muscles, primary spindle endings must be associated with relatively small afferent nerve fibers. The pelvic urethra received more large myelinated afferent fibers than the penis. The three divisions of the external anal sphincter muscle had three distinct populations of muscle fibers, based on size distribution. The homologous bulbospongiosus and constrictor vulvae muscles had different populations of muscle fibers.

During the past decade the ability to assess urinary bladder function in diabetes mellitus has improved considerably because of changed concepts of urinary bladder function, imporved methods for evaluation, and increased capability for treatment. Evaluation of patients with urinary bladder dysfunction and diabetes mellitus has shown that peripheral visceral afferent pathways are first affected, followed by detrusor reflex decompensation.

The terminology of lower urinary tract function will be standardized by the ICS. This report contains the recommendations dealing with urinary incontinence, procedures related to the evaluation of urine storage (cystometry, urethral closure pressure profile) and units of measurement.