New insights in the neuroanatomy of the human adult superior hypogastric plexus and hypogastric nerves

Kraima, Anne C.; Schaik, Jan van; Susan, Serhat; Velde, C.J.H. van de; Hamming, Jaap F.; Lakke, E.A.J.F.; DeRuiter, M.C.

doi:10.1016/j.autneu.2015.02.001

Cited by 20 publications

(11 citation statements)

References 22 publications

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“…The lateral roots originate mainly from the lowest lumbar splanchnic nerves (LSNs) [2] and contain a sympathetic component [17]. The median root, or a continuation of the abdominal aortic plexus from the inferior mesenteric plexus [15,17], contains both sympathetic and parasympathetic components [12]. The SHP is divided into paired hypogastric nerves at the same level or below the sacral promontory [15,17,18,21].…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Kim

Nam²,

Lee³

et al. 2021

Folia Morphol

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Background:The purpose of this study was to clarify the anatomy of the superior hypogastric plexus, which would contribute to advancement of nerve-sparing paraaortic lymphadenectomy. Materials and methods:Eighteen cadavers were dissected and morphometrically analyzed based on photographic images. Anatomical landmarks such as aortic bifurcation, transitional points of abdominal aorta to bilateral common iliac arteries, and cross point of the right ureter and pelvic brim, and cross point of sigmoid mesentery and pelvic brim were selected as reference points. Results:The left lowest lumbar splanchnic nerve was located more laterally to transitional point of abdominal aorta to in 11/18 specimens, whereas the right lowest lumbar splanchnic nerve passed onto the right transitional point in only one specimen. The lowest lumbar splanchnic 2 nerves or the superior hypogastric plexus covered the aortic bifurcation in 11/18 specimens. The superior hypogastric plexus was separate from the cross point of right ureter and pelvic brim as well as cross point of sigmoid mesentery and pelvic brim. Conclusions:The SHP is at risk of injury during paraaortic lymphadenectomy because of its topography. Preservation of the superior hypogastric plexus regarding its anatomic basis during paraaortic lymphadenectomy is required.

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Section: Introductionmentioning

confidence: 99%

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Kim

Nam²,

Lee³

et al. 2021

Folia Morphol

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“…On the contrary, the posterosuperior area (between the rectum and levator ani muscle) and the posteroinferior area (at and along the posterolateral corner of the prostate) contained VIP-positive nerve fibers. The hypogastric and pelvic splanchnic nerves both contain nNOS-, VIP-, and TH-positive nerves [ 14 , 15 ]. Kraima et al [ 15 ] reported that VIP-positive fibers were not present in tissues isolated from the lumbar sympathetic chain; thus, areas that do not include VIP-positive nerves may be supplied by the lumbar sympathetic chain.…”

Section: Discussionmentioning

confidence: 99%

“…The hypogastric and pelvic splanchnic nerves both contain nNOS-, VIP-, and TH-positive nerves [ 14 , 15 ]. Kraima et al [ 15 ] reported that VIP-positive fibers were not present in tissues isolated from the lumbar sympathetic chain; thus, areas that do not include VIP-positive nerves may be supplied by the lumbar sympathetic chain. In addition, a non-parasympathetic pattern [−, −, +] was not evident in the plexus branches, but was observed both inside and outside of the levator ani muscle; these nerves appeared to be pudendal nerve branches.…”

Section: Discussionmentioning

confidence: 99%

Site-dependent differences in the composite fibers of male pelvic plexus branches: an immunohistochemical analysis of donated elderly cadavers

et al. 2018

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BackgroundAlthough the pelvic autonomic plexus branches are considered to be a mixture of sympathetic and parasympathetic nerves, little is known regarding the composite fibers of the pelvic plexus branches. This study aimed to investigate the immunohistochemical features of sympathetic and parasympathetic nerves in the pelvic autonomic plexus branches.MethodsUsing 10 donated elderly male cadavers, the detailed topohistology of nerve fibers at and around the bladder, seminal vesicle, prostate, and rectum was examined. Neuronal nitric oxide synthase (nNOS) and vasoactive intestinal polypeptide (VIP) were used as parasympathetic nerve markers; tyrosine hydroxylase (TH) was used as a sympathetic nerve marker. The myenteric plexus of the colon was utilized as a positive control.ResultsMost nerve fibers in the bladder, seminal vesicle, prostate, and rectum were both nNOS- and TH-positive. Thus, pelvic plexus branches were classified into two types: 1) triple-positive mixed nerves (nNOS+, VIP+, TH+, thick myelinated fibers + or -) and 2) double-positive mixed nerves (nNOS+, VIP-, TH+, thick myelinated fibers + or -). Notably, triple-positive nerves were localized within the posterosuperior part of the plexus (near the rectum) and travelled anteroinferiorly toward the posterolateral corner of the prostate. The posteriorly and inferiorly located nerves were predominantly composed of parasympathetic, rather than sympathetic, fibers. In contrast, nerve fibers within and along the bladder and seminal vesicle contained either no or few VIP-positive nerves. These superiorly located nerves were characterized by clear sympathetic nerve dominance.ConclusionsThe nerves of the pelvic plexus branches were clearly classified into nerves around the bladder and seminal vesicle (VIP-negative) and nerves around the prostate (VIP-positive). Although nNOS- and VIP-positive nerve fibers are candidate cavernous nerves, cavernous nerve identity cannot be definitively concluded for these nerves in the periprostatic region.

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“…The uterus, bladder and rectum are innervated by the hypogastric plexus, with sensory axons converging at the same dorsal root ganglion T10–L1. The vagina, clitoris and vulva as well as parts of the bladder, cervix and rectum also have sensory input from the sacral nerves (S2–S4) and also share sensory processing in the dorsal root ganglion of S2–S4 [6,7]. These communal information centers increase the risk of neuronal dysfunction in the pelvis, resulting in a unique cross-over effect.…”

Section: Pelvic Innervationmentioning

confidence: 99%

New Developments in the Pharmacotherapy of Neuropathic Chronic Pelvic Pain

Carey

As‐Sanie

2016

Future Science OA

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Advancements in further understanding the pathophysiology of chronic pelvic pain syndromes continue to direct therapy. The mechanisms of chronic pelvic pain are often multifactorial and therefore require a multidisciplinary approach. The final treatment plan is often an accumulation of organ-specific treatment and chronic pain medications directed to the CNS and PNS. This article is a review of commonly used medications for chronic pelvic neuropathic pain disorders as well as an introduction to recent innovative developments in pain medicine.

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New insights in the neuroanatomy of the human adult superior hypogastric plexus and hypogastric nerves

Cited by 20 publications

References 22 publications

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Site-dependent differences in the composite fibers of male pelvic plexus branches: an immunohistochemical analysis of donated elderly cadavers

New Developments in the Pharmacotherapy of Neuropathic Chronic Pelvic Pain

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