Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy

Abstract

Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who received laparoscopic nerve-sparing radical hysterectomy (NSRH) in a randomized controlled study. However, the definite reasons for these results were unknown. This subgroup analysis compared the neural areas and impairment in the IHP uterine branches harvested during NSRH as an alternative to the IHP vesical branches between the waterjet and control groups. This study included samples from 30 eligible patients in each group of the trial NCT03020238. At least one specimen from each side of the IHP uterine branches was resected. The tissues were scanned, images were captured, and the neural component areas were calculated using the image segmentation method. Immunohistochemical staining was used to evaluate neural impairment. The control and waterjet groups had similar areas of whole tissues sent for evaluation. However, the control group had significantly fewer areas (median 272158 versus 200439 μm2, p = 0.044) and a lower percentage (median 4.9% versus 3.0%, p = 0.011) of neural tissues. No significant changes in immunohistochemical staining were found between the two groups. For patients with residual urine ≤100 and >100 ml at 14 days after NSRH (42 and 18 patients, respectively), there were significantly different percentages of neural tissues in the resected samples (p < 0.001). Hence, Due to the accurate identification of IHP during NSRH, the waterjet dissection technique achieved better urodynamic results.

Laparoscopic nerve‑sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials

“…And the sample size included may be not enough to detect the potential differences length of parametrial tissue excised and the length of vagina. It is generally believed that a successful LNSRH results in a catheter indwelling time of about 10 days [ 43 ]. The results of this study have confirmed the effect of preserving pelvic autonomic nerves on reducing bladder dysfunction.…”

Nerve-sparing surgery in current gynecologic oncology

“…Injuries of the hypogastric nerve may cause urinary dysfunction in female patients, and lead to incontinence (12) . Retroaortic lymph nodes should be dissected with special attention to the lumbar vessels and the affluent vein.…”

Past, Present, and Future in the Study of Neural Control of the Lower Urinary Tract

“…Recently, Alsaid et al [10] showed coexistence of both parasympathetic and sympathetic fibers for both courses. Li et al [11] showed the scant paucity and the delicate nature of these neurons scattered within the IHP, consisting about 4% of the cross section. Modern investigations of the IHP underscores the significant lack of tools available to classical anatomists to understand functional neurourology.…”