Anatomy of the pelvic plexus and innervation of the prostate gland

Ali, M. Adam; Johnson, Ian; Hobson, Jonathan; Mohammadi, Borzoueh; Khan, Fakhar Z.

doi:10.1002/ca.10187

Cited by 28 publications

(16 citation statements)

References 36 publications

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“…It is delimited cranially by the rectovesical pouch of Douglas. The septum rectovesicale, extending in a coronal plane, divides the space into a retrovesical or retroprostatic space, anteriorly, and into a prerectal space, posteriorly (Diop et al, 2003;Ali et al, 2004;Venuti et al, 2004;Standring et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Histotopographic study of the rectourethralis muscle

et al. 2005

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Radical perineal prostatectomy, relative to retropubic prostatectomy, has become an increasingly used surgical technique for prostate cancer, following advances in laparoscopic methods for pelvic lymph node dissection. Recent protocols of risk stratification may even obviate the need for lymph node dissection. Section of the rectourethralis muscle (RUM) is necessary for access to the retroprostatic space, however, during this procedure rectal injuries may be produced. In this work, we studied the topography and morphology of the RUM, which, despite its importance in perineal surgery, has not been univocally described in the literature. After in situ formalin fixation, the pelvic viscera were removed from 16 male cadavers (age: 54-72 years) and from 4 full-term infants (gestational age: 37-38 weeks). Serial macrosections of the bladder base, prostate gland, and lower rectum cut in horizontal (6 adults and 2 infants) and sagittal (6 adults and 2 infants) planes underwent histological (hematoxylin and eosin, azan-Mallory, and Weigert's staining) and immunohistochemical (anti-smooth muscle actin and anti-sarcomeric actin) study. The remaining 4 adult specimens were cut in horizontal and sagittal planes and plastinated using the epoxy resin E12 sheet procedure. RUM was identified in 10 of 12 (83%) adult specimens and in 4 of 4 (100%) infant specimens. In both sagittal and transverse sections, it showed a triangular-shaped configuration. In all cases, at the level of its posterior portion, fibers continuing with the longitudinal muscular layer of the rectum were visible. In the majority of adult and infant cases, attachment of muscle fibers into the anterior wall of the anal canal was also observed. Anteriorly, the mean (+/-SD) distance between the RUM and the membranous urethra was 5.3 (+/-1.25) mm in adults and 1.0 (+/-0.41) mm in infants. Location of RUM in the prerectal space and the absence of urethral attachment makes the original name of this muscle, "prerectal," by Henle, more correct. In 7 of 10 (70%) adult cases and in 1 of 4 (25%) infant cases, muscle fibers were densely packed along the lateral portions of the RUM, while in its central portion connective tissue was prevalent, with sparse numbers of smooth muscle fibers. Immunohistochemical staining showed that this muscle consists almost entirely of smooth fibers. In all the infant specimens, the RUM was clearly separated from the levator ani, while in 8 of 10 (80%) adult cases, striated fibers of the levator ani and smooth fibers of the RUM intermingled. These structural associations suggest a functional cooperation between the two muscles, particularly in determining the anorectal flexure.

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Section: Discussionmentioning

confidence: 99%

Histotopographic study of the rectourethralis muscle

et al. 2005

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“…Anatomical studies, in contrast, are more feasible and could help guide subsequent functional studies. We previously showed that the position of the inferior hypogastric plexus can be located consistently in the cadaver with the use of surgical landmarks [17]. The present study builds upon these observations determine the extent to which the fascia containing the fine branches of this plexus can be put under tension by the movement of pelvic organs.…”

Section: Introductionmentioning

confidence: 52%

“…The position of the plexus in the endopelvic fascia was taken as two fingers breadth lateral to the third anterior sacral foramina, lying deep to a line drawn from the thirds sacral vertebra, the conventional level of the rectosigmoid junction, and the palpable posterior surface of the pubic symphysis [17]. Taking care to remain superficial to the endopelvic fascia, a note was made of the relations of this fascia and the ease with which displacement of this fascia could be produced by gentle movement of related visceral structures to an extent that was considered to reflect the range possible during life.…”

Section: Methodsmentioning

confidence: 99%

Colorectal and uterine movement and tension of the inferior hypogastric plexus in cadavers

Johnson

2012

Chiropr Man Therap

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BackgroundHypotheses on somatovisceral dysfunction often assume interference by stretch or compression of the nerve supply to visceral structures. The purpose of this study is to examine the potential of pelvic visceral movement to create tension of the loose connective tissue that contains the fine branches of the inferior hypogastric nerve plexus.MethodsTwenty eight embalmed human cadavers were examined. Pelvic visceral structures were displaced by very gentle 5 N unidirectional tension and the associated movement of the endopelvic fascia containing the inferior hypogastric plexus that this caused was measured.ResultsMost movement of the fascia containing the inferior hypogastric plexus was obtained by pulling the rectosigmoid junction or broad ligament of the uterus. The plexus did not cross any vertebral joints and the fascia containing it did not move on pulling the hypogastric nerve.ConclusionsUterine and rectosigmoid displacement produce most movement of the fascia containing the hypogastric nerve plexus, potentially resulting in nerve tension. In the living this might occur as a consequence of menstruation, pregnancy or constipation. This may be relevant to somatovisceral reflex theories of the effects of manual therapy on visceral conditions.

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“…In male mammals, PP (similarly as indicated above in females) extends caudally on both sides of the rectum and reaches the border of the vas deferens and seminal vesicles (Tsaknakis 1971). However, in males of large mammals PP comprises of one large ganglion called the anterior pelvic ganglion (APG) and several smaller in size ganglia scattered throughout the plexus (Kaleczyc et al 2003a, Ali et al 2004. In males and females of rodents, the structure of PP is even more simplified since in animal species such as the rat, guinea-pig or mouse one large major pelvic ganglion (MPG) and only a few small accessory pelvic ganglia are present (Dhami and Mitchell 1991, Mitchell 1993, Keast 1995, Wanigasekara et al 2003.…”

Section: Introductionmentioning

confidence: 91%

Distribution and immunohistochemical characteristics of cocaine- and amphetamineregulated transcript-positive nerve elements in the pelvic ganglia of the female pig

Zacharko-Siembida¹,

Matysek²,

Szalak³

et al. 2017

Polish Journal of Veterinary Sciences

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Cocaine-and amphetamine-regulated transcript (CART) peptides are widely expressed not only in the brain but also in numerous endocrine/neuroendocrine cells as well as in neurons of the peripheral nervous system. The present study investigated the distribution patterns of CART-like immunoreactivity in the pelvic plexus (PP) of the female pig. The co-expression of CART with principal neurotransmitter markers: choline acetyltransferase (ChAT), tyrosine hydroxylase (TH), serotonin (5-HT) or biologically active neuropeptides: pituitary adenylate cyclase-activating polypeptide (PACAP), substance P (SP), calbindin was analyzed using double immunohistochemical stainings. Amongst neurons immunopositive to Hu C/D panneuronal marker as many as 4.1 ± 1.2% in right and 4.4 ± 1.6% in left pelvic ganglia were found to express CART. The vast majority of CART-IR ganglionic neurons were predominantly small in size and were evenly scattered throughout particular ganglia. Immunoreactivity to CART was also detected in numerous nerve terminals (which frequently formed pericellular formations around CART-negative perikarya) as well as in numerous nerve fibres within nerve branches interconnecting the unilateral pelvic ganglia. Immunohistochemistry revealed that virtually all CART-IR neurons were cholinergic in nature and CART-IR basket-like formations frequently encircled TH-positive/CART-negative perikarya. None of CART-IR ganglionic neurons showed immunoreactivity to SP, PACAP, 5-HT or calbindin. CART-IR nerve fibres ran in a close vicinity to serotonin-containing cells or faintly labelled SP-expressing neurons. On the other hand, PACAP-IR, SP-IR (but not 5-HT-positive) nerve terminals were found to run in close proximity to CART-IR neurons. Our results indicate that: 1) CART present in PP may influence the activity of pelvic ganglionic neurons/SIF cells, 2) PP should be considered as a potential source of CART-like supply to pelvic viscera and 3) functional interactions between CART and SP or PACAP are possible at the periphery.

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Anatomy of the pelvic plexus and innervation of the prostate gland

Cited by 28 publications

References 36 publications

Histotopographic study of the rectourethralis muscle

Histotopographic study of the rectourethralis muscle

Colorectal and uterine movement and tension of the inferior hypogastric plexus in cadavers

Distribution and immunohistochemical characteristics of cocaine- and amphetamineregulated transcript-positive nerve elements in the pelvic ganglia of the female pig

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