Investigation of the Localization of Nerves in the Uterosacral Ligament: Determination of the Optimal Site for Uterosacral Nerve Ablation

Fujii, Masashi; Sagae, Satoru; Satô, Toshio; Tsugane, M.; Murakami, Gen; Kudo, Ryuichi

doi:10.1159/000066289

Cited by 22 publications

(10 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, in two specimens (18%) they emerged from S1 and climbed medially through the IHP. So far, a single mention could be found of the existence of a pelvic sacral nerve emerging from the ventral branches of S1-S4 running inside the uterosacral ligament (Fujii et al, 2002). It has yet to be established on a larger scale whether S1 generally gives rise to a pelvic sacral nerve.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Recent anatomical studies by Fujii et al showed that the majority of uterosacral nerve fiber bundles were found at a distance of 6.5-33 mm and at a depth of 3-5 mm distal to the site of attachment of the uterosacral ligaments to the cervix. (9,10) ( Fig. 1).…”

Section: Laparoscopic Uterine Nerve Ablation (Luna) Proceduresmentioning

confidence: 99%

The Role of Laparoscopic Uterine Nerve Ablation (LUNA) and Presacral Neurectomy (PSN) of Pelvic Pain Management

adi¹,

Mishra²

2008

WJOLS

View full text Add to dashboard Cite

Background: The chronic pelvic pain as non-cyclical pain is serious enough to cause disability or lead to medical care. While these treatments are very successful there is still a 20 to 25% failure rate and surgery has been an option for such cases. Effectiveness of laparoscopic uterosacral nerve ablation (LUNA) and presacral neurectomy (PSN) can be useful for alleviating chronic pelvic pain. Objectives: To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrheal in the chonic pelvic pain. Data sources: Various watchfulness sources related to surgically chronic pelvic pain treatment from various causes and journals, also involve the

show abstract

“…It has been suggested that division of the uterosacral ligaments approximately 1.5 cm distal to the cervix should interrupt many sensory nerve fibers of the cervix and uterine corpus, and Doyle suggested that this was possible even through the vaginal route [5]. However, anatomical studies showed that the majority of uterosacral nerve fibers were found at a distance of 6.5-33 mm and at a depth of 3-5 mm distal to the attachment site of the uterosacral ligaments to the cervix [26]. There are widespread variations in the technique performed, including the route of surgery, the site of nerve ablation, and the method used for nerve ablation such as laser, electrodiathermy, scissors cutting, or harmonic scalpel [27].…”

Section: Uterosacral Nerve Ablationmentioning

confidence: 99%

Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Uğurlucan¹,

Yaşa²

2021

Chronic Pain - Physiopathology and Treatment

View full text Add to dashboard Cite

Chronic pelvic pain affects 2-24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea-and endometriosis-related pain. But recent randomized studies and metaanalysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter.

show abstract

Investigation of the Localization of Nerves in the Uterosacral Ligament: Determination of the Optimal Site for Uterosacral Nerve Ablation

Cited by 22 publications

References 10 publications

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

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

The Role of Laparoscopic Uterine Nerve Ablation (LUNA) and Presacral Neurectomy (PSN) of Pelvic Pain Management

Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Contact Info

Product

Resources

About