PubMed · 15426489
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S ROSEN. 1950. The tympanic plexus; an anatomic study.. https://doi.org/10.1001/archotol.1950.00700030034003
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For people with spinal cord injuries, the impact of bladder, bowel and sexual problems on quality of life and lost opportunities can be devastating. Supra-sacral spinal lesions can cause incontinence by interrupting those pathways that normally coordinate the function of the bladder, bowel and sphincters. From a scientific perspective, neural control of the pelvic organs is one of the most intriguing in the body, involving both somatic and autonomic pathways participating in an exquisitely fine integration of lumbo-sacral reflexes. This chapter aims to review briefly those aspects of neural control of the pelvic organs that are amenable to neurophysiological examination in man. More specifically, it will focus in greater detail on the interactions of somatic and autonomic lumbo-sacral pathways responsible for coordinating the bladder and sphincters. Where appropriate, it will make comparisons with those controlling the bowel. It will describe how measurement of pelvic floor and sphincter reflexes can be used to assess the modulatory effects of sacral autonomic pathways on sacral somatic reflexes and vice versa including the so-called "guarding reflex" and vesical inhibitory reflexes. Aberrant activity following spinal cord injury (SCI), such as bladder hyperreflexia and sphincter dyssynergia, will be discussed in relation to these reflexes. The effects of volitional modulation of pelvic floor reflexes in people with both complete and incomplete lesions will be described. Finally, the chapter will address the possible utility of neurophysiological measures for complementing the established neurological classification and the assessment of somatic sensory-motor impairment in SCI.
Neurogenic bladder caused by SCI or spina bifida is a major problem. Research in restoring functional micturition has mainly focused on electrical stimulation for many decades with good progress, but it is still not the definitive solution for majority of the SCI patients. An alternative approach has been to investigate restoring innervation to the lower urinary tract after spinal SCI. Different animal and clinical studies were reviewed historically in this article, focused on mainly cross over nerve surgery for reinnervation of the bladder. An artificial somatic-autonomic reflex pathway procedure and its mechanisms were introduced. Clinical application and the satisfactory results of the new procedure were reviewed in details in restoring voluntary bladder control in patients with SCI or spina bifida.
With the introduction of total mesorectal excision (TME) for treatment of rectal cancer, the prognosis of patients with rectal cancer is improved. With this better prognosis, there is a growing awareness about the quality of life of patients after rectal carcinoma. Laparoscopic total mesorectal excision (LTME) for rectal cancer offers several advantages in comparison with open total mesorectal excision (OTME), including greater patient comfort and an earlier return to daily activities while preserving the oncologic radicality of the procedure. Moreover, laparoscopy allows good exposure of the pelvic cavity because of magnification and good illumination. The laparoscope seems to facilitate pelvic dissection including identification and preservation of critical structures such as the autonomic nervous system. The technique for laparoscopic autonomic nerve preserving total mesorectal excision is reported. A three- or four-port technique is used. Vascular ligation, sharp mesorectal dissection and identification and preservation of the autonomic pelvic nerves are described.