The anatomy of the male inferior hypogastric plexus: What should we know for nerve sparing surgery

Abstract

The aim of this study was to investigate the nerve supply to the structures in the male lesser pelvis and review its clinical relevance, especially during nerve sparing surgery. Three formalin-embalmed and 16 Thiel-embalmed male hemipelves were used. They were microdissected after repeated treatments with nitric acid diluted 1:10 with milliQ-water. The inferior hypogastric plexus (IHP) is a fan-like structure lateral from the rectum on the fascia of the levator ani. Nerves emerging from the proximal, solid part of the plexus follow the internal iliacal vessels and reach the prostate from dorsolateral. The innervation of the urethra and the corpora cavernosa derives from two origins: one follows the ejaculatory duct and the seminal vesicle, reaching the proximal urethra and the prostate from dorsal; the other follows the inferior vesical artery to reach the prostate from lateral, and then forms the neurovascular bundle on both sides of the prostatic fascia, spreading to the pelvic floor muscles and the corpora cavernosa along with the distal urethra. A connection between the two parts was demonstrated in approximately one third of the samples investigated. The nerve supply to the urinary bladder, the urethra, and the corpora cavernosa emerges mainly from the IHP. The innervation of the proximal urethra and its autonomic muscular structures has a dorsal (ejaculatory duct) and lateral (inferior vesical artery) origin. To maintain good erectile and continence function it is important to save both the dorsal and lateral neurovascular roots. Clin. Anat. 31:788-796, 2018. © 2018 Wiley Periodicals, Inc.

Anatomy of Cowper’s gland in humans suggesting a secretion and emission mechanism facilitated by cooperation of striated and smooth muscles

“…A study on the EUS reported that it is difficult to analyze because its overall shape is unclear due to growth of the prostate and the invasion of the prostatic vascular plexuses, and that the textbook descriptions are inconsistent 7 . Although the term "sphincter" is reminiscent of a circular muscle, it has been reported that the EUS is horseshoe-shaped rather than perfectly circular 9,22,23 . Our group clarified that horseshoe-shaped EUS is not an independent muscle, but is formed from partial muscle bundles of the EAS, STP, and LA so it is continuous with the surrounding pelvic floor muscles 12 .…”

Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center Study

“…This might be because the hypogastric nerve fibers, which run along the tip of the SV, can be spared more extensively with the SVS approach as compared to the NS approach. 3,30 Therefore, in order to optimize urinary continence, we always aim at sparing the SV if it is safe from an oncological standpoint; this is the reason we perform SVS in some patients even with decreased erectile function preoperatively. Hence, although baseline sexual function clearly plays an important role in the decision whether the aim should be SVS, it is not the only variable we take into account.…”

“…Furthermore, a connection between the two parts was demonstrated in approximately one third of the samples investigated. This could explain the significantly better recovery of continence after pelvic surgery 30 .…”

“…However, we could show that UC-recovery was significantly better in the SVSgroups during daytime (OR 2.64 to 5.21) and, less pronounced, during nighttime (OR 1.08 to 4.37) in any of our comparisons. This might be because the hypogastric nerve fibres which run along the tip of the SV can be spared more extensively with the SVS-approach as compared to the NS-approach 3,30 . Therefore, in order to optimize urinary-continence, we are always aiming at sparing the SV if it's safe from an oncological standpoint.…”

Ectopic sympathetic ganglia cells of the ventral root of the spinal cord: an anatomical study

“…In sum, our findings elucidate ectopic sympathetic neurons in the ventral root of the human spinal cord. Such findings are important for better understanding of the variations of the human nervous system [30][31][32][33].…”