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PubMed1995

Laparoscopic treatment of chronic pelvic pain in 100 adult women.

STUDY OBJECTIVE: To evaluate the effectiveness of laparoscopic surgical treatment for women with chronic pelvic pain. DESIGN: Prospective evaluation of women treated consecutively between January 1, 1989, and December 31, 1992. SETTING: A private practice. PATIENTS: One hundred women with chronic pelvic pain. INTERVENTIONS: Laparoscopic treatment was performed in all patients. Pain level was rated on a scale of 1 to 10 (1 = no pain, 10 = severe, disabling pain). Patients recorded their pain levels before and 1 month, 3 months, and 6 months after surgery, as well as at intervals of 1, 2, and 3 years after surgery. MEASUREMENTS AND MAIN RESULTS: Preoperatively, the average pain level reported by the patients was 8.2. At 1 month after laparoscopic surgical therapy, it had dropped to 3.6, at 6 months to 1.9, and at 3 years to 2.2. Twenty patients reported pain levels of 5 or greater at the 6-month interval. Six of them proceeded to hysterectomy, and four of these six were found to have adenomyosis. Eleven of the 100 who had pain levels greater than 5 after initial procedure had no further therapy, and 3 underwent repeat laparoscopy. CONCLUSION: Extensive laparoscopic surgery to restore normal pelvic anatomy and remove all diseased tissue, including treatment of all endometriosis, resection of ovarian cysts, resection of adhesions, removal of the appendix, and treatment of hernias when indicated, together with laparoscopic uterosacral nerve vaporization or presacral neurectomy, results in significant improvement in reported pain levels.

Adolescent↗
PubMed1994

Laparoscopic presacral neurectomy for treatment of midline pelvic pain.

STUDY OBJECTIVE: To examine the efficacy and safety of laparoscopic presacral neurectomy (LPSN) as the initial surgical treatment of midline pelvic pain and dysmenorrhea; and to evaluate its effectiveness in conjunction with procedures to relieve lateral pelvic pain, such as excision of endometriosis and lysis of adhesions. DESIGN: A preoperative and postoperative self-rating with which patients classified pain on an ordinal scale of 0 to 5. A x 2 analysis of the data was performed. SETTING: A private hospital in Savannah, Georgia. PATIENTS: Twenty-seven women, age 15 to 41 years, who experienced severe midline dysmenorrhea and/or pain; 12 also had significant lateral pain. INTERVENTIONS: Laparoscopic presacral neurectomy was the primary intervention. Other procedures, including lysis of adhesions, excision and vaporization of endometriosis, and appendectomy were completed as adjuncts to LPSN. MEASUREMENTS AND MAIN RESULTS: Ratings were completed by patients 5 to 35 months after surgery. Twenty-two women reported no midline pain, three had significant reduction of pain, and two had persistence of severe pain. Two of the 12 women with lateral pain reported that pain persisted. CONCLUSIONS: The LPSN is safe and effective as an initial surgical intervention for treating midline dysmenorrhea and pelvic pain, and when it is performed by experienced laparoscopic surgeons with adequate training.

Adipose Tissue↗
PubMed1999

Relationship of gynecologic surgery to constipation.

STUDY OBJECTIVE: To determine if women undergoing presacral neurectomy, hysterectomy, or other gynecologic surgery experience a greater frequency of constipation than those having no surgery. DESIGN: Concurrent, nonrandomized, retrospective study (Canadian Task Force classification II-2). SETTING: Tertiary medical care center with referral-based practice for the treatment of chronic pelvic pain. PATIENTS: Two hundred fifty-six women forming four groups based on surgical procedure: presacral neurectomy (66), hysterectomy (65), other gynecologic surgery (68), and no surgery (57). INTERVENTIONS: Laparoscopic presacral neurectomies. Other gynecologic surgery included laparoscopy, dilatation and curettage, laparoscopic resection of endometriosis, or any combination of these procedures. MEASUREMENTS AND MAIN RESULTS: Constipation was defined as decrease in frequency of spontaneous bowel movements. A statistically significant greater percentage of patients undergoing surgical procedures were more constipated than those having no surgery: presacral neurectomy, 31.8%; hysterectomy, 27.7%; other gynecologic surgery, 25%; and no gynecologic surgery, 10.5%. CONCLUSION: Pelvic surgery may cause parasympathetic nerve dysfunction leading to constipation. (J Am Assoc Gynecol Laparosc 6(1):75-78, 1999)

Adult↗
PubMed2002

Differential susceptibility to ageing of rat preganglionic neurones projecting to the major pelvic ganglion and of their afferent inputs.

We have analysed age-related changes in the morphology of preganglionic neurones in the lumbosacral spinal cord, labelled following injection of retrograde tracers into the major pelvic ganglion of young adult and aged male rats. We have also examined changes in neurotransmitter-characterised spinal afferent inputs to these neurones, or to the nuclei in which they lie, using light and electron microscope immunohistochemistry. In previous investigations of the major pelvic ganglion, the sympathetic, but not parasympathetic, postganglionic neurones were seen to exhibit age-related changes and the same pattern is seen in the preganglionic neurones. This included an apparent reduction in the numbers of sympathetic preganglionic neurones, and a reduction in the length of their dendrites and the complexity of their branches. Ultrastructural immunohistochemical studies described here reveal significant reductions in the area of synaptic contact made by glutamate-immunoreactive boutons onto the dendrites of sympathetic (but not parasympathetic) preganglionic neurones, while contacts from boutons immunoreactive for glycine or gamma-aminobutyric acid (GABA) were unchanged. There is also a reduction in synaptic contacts received by sympathetic somata from boutons immunoreactive for none of these amino acids. Serotonin-immunoreactive terminals are closely associated with preganglionic autonomic neurones, and these are reduced in number in sympathetic, but not parasympathetic, spinal nuclei of aged rats. However, serial section electron microscopy has so far failed to demonstrate conventional synaptic contacts between serotonergic terminals and the dendrites or somata of the preganglionic autonomic neurones. In young animals, axon terminals immunoreactive for thyrotropin-releasing hormone (TRH) are abundant in all spinal laminae including area X, but in aged animals, such terminals are significantly reduced in number in regions containing preganglionic sympathetic, but not parasympathetic, neurones. These results indicate that the sympathetic preganglionic neuron populations that project to the major pelvic ganglion, and the spinal inputs they receive, show a number of degenerative changes in aged rats which are not seen parasympathetic preganglionic neuronal populations.

Afferent Pathways↗
PubMed2003

Control of canine membranous urethra, bulbocavernosus and ischiocavernosus muscles by lumbosacral sympathetic pathways.

The membranous urethral muscles, bulbocavernosus muscle (BCM) and ischiocavernosus muscle (ICM) play a significant role on expulsion at ejaculation. Projection of the sympathetic pathways in the retroperitoneum to these muscles was investigated in the dog. Intraluminar pressure of the membranous urethra and contractions of the BCM and ICM to electrical stimulation of the lumbar splanchnic nerve (LSN) or the lumbosacral sympathetic chain (LSC) were examined. Stimulation of the LSN was performed after transection of the unilateral hypogastric nerve (HGN) to clarify its cross-innervation. Stimulation of each of the 2nd to 4th LSNs elicited elevation of the intraluminal pressure of the membranous urethra. In eight dogs whose right HGNs were transected, 15 of the 19 right LSNs, and 12 of the 16 left LSNs examined elicited elevation of the membranous urethral pressure, respectively. In five dogs whose left HGNs were transected, 6 of the 9 right LSNs and 10 of the 12 left LSNs stimulated elicited elevation of the pressure. Stimulation of the HGN caused no detectable contractions of the BCM and ICM in all six dogs examined. Stimulation of the LSC elicited responses of the BCM and ICM in all six dogs examined and the membranous urethra in three of six dogs. The maximum value of the response of the BCM was greater than that of the ICM. After consecutive transection of the ipsilateral pelvic nerve, stimulation of the LSC showed no significant changes in the responses of the BCM and ICM. The above results indicate the following: (1). each of the L2-L4 LSNs sends signals to the membranous urethra via two routes, passing through the ipsilateral or contralateral HGN; (2). the above nerve does not send effective signals to the BCM and ICM; (3). the LSC sends signals to the membranous urethra, BCM and ICM; (4). the signals from the LSC mainly pass through the pudendal nerve to the BCM and ICM; and (5). the signals were dominant to the BCM compared with the ICM.

Animals↗
PubMed1979

Physiological and pharmacological basis for the chemotherapy of enuresis.

Enuresis is a disorder of micturition occuring in the absence of an organic urinary tract lesion. To understand its possible causation, the mechanisms controlling micturition are described together with the possible sites of action of various anti-enuretic agents, particularly imipramine. It is concluded that further research into the central control of micturition is required before the precise actions of centrally-acting anti-enuretic agents can be elucidated. Knowledge of these may give insight into the nature of the defect causing enuresis.

Adolescent↗
PubMed2001

Slow transit constipation: a disorder of pelvic autonomic nerves?

Slow transit constipation (STC) is a severe motility disorder, which in the majority of cases is of unknown etiology. In some, symptoms arise de novo in childhood, but a proportion of patients present in later life, including after pelvic surgery or childbirth. Our aims were: (1) to describe our current knowledge of the anatomy and function of the pelvic autonomic nerves with respect to colonic motility (experimental and observational studies); (2) to discuss evidence for pelvic nerve injury in STC arising after pelvic surgery or childbirth; and (3), on the basis that such patients are clinically indistinguishable from patients with chronic idiopathic STC, to evaluate whether there is evidence that pelvic autonomic neuropathy has an etiologic role in patients with chronic idiopathic STC. The outcome was as follows: (1) The clear importance of the pelvic autonomic nerves in colonic motor function is documented. (2) While there is an association between pelvic surgery and childbirth, and the onset of STC, there is little direct anatomical evidence that pelvic denervation occurs in these patients. However the phenotype of these patients is similar to results of experimental and observational studies. (3) Clinical, physiological, and histological similarities exist between patients whose symptoms arose following pelvic intervention and those whose symptoms arise de novo (idiopathic). We further present evidence for possible pathogenetic mechanisms underlying pelvic autonomic neuropathy in chronic idiopathic STC.

Autonomic Nervous System Diseases↗
PubMed2000

A comparison of the hemodynamic effects of paracervical block and epidural anesthesia for labor analgesia.

BACKGROUND: Both paracervical block (PCB) and epidural analgesia are sometimes associated with hemodynamic effects potentially harmful to the well-being of the fetus. Our study was designed to test the hypothesis that PCB would have a more profound effect on maternal and fetal blood flow than epidural analgesia. METHODS: Forty-four healthy primiparous parturients were randomized to receive either PCB (n=21) or epidural analgesia (n= 23) with 25 or 30 mg of bupivacaine, respectively, for labor analgesia. Maternal blood pressure and fetal heart rate were recorded. Blood flow was measured using a color Doppler device. The blood flow measurements consisted of assessment of the pulsatility indices (PI) of the right maternal femoral artery and the main branch of the uterine artery (placental side), the umbilical artery and the fetal middle cerebral artery. The measurements were performed before administration of analgesia and approximately 15-20 min later after the onset of analgesia. RESULTS: Both methods provided in general good analgesia, but rescue medication was required more often after PCB. Epidural analgesia decreased maternal blood pressure more than PCB and the PI of maternal femoral artery decreased after onset of epidural analgesia, indicating epidural-induced vasodilation. The PI of the uterine artery increased after the onset of PCB, indicating vasoconstriction of this artery. No significant adverse effects or differences in the well-being of the newborn were observed, as indicated by similar Apgar scores and pH-status. CONCLUSION: There were small differences in the effects of PCB and epidural analgesia on uteroplacental circulation as well as on maternal hemodynamics. PCB may have a vasoconstrictive effect on the uterine artery. This and the fact that the parturients required rescue analgesia more frequently after PCB than after epidural block speaks for the feasibility of the latter in obstetrics.

Adult↗
PubMed2001

Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia.

BACKGROUND: By choosing spinal anaesthesia instead of general anaesthesia, and by infiltrating the wound area with local anaesthetic the need for postoperative analgesics may be reduced. An ilioinguinal and iliohypogastric nerve block (IINB) in inguinal herniorrhaphy was, therefore, studied in a day surgery setting in combination with a spinal block. METHODS: One hundred ASA I-II adult patients scheduled for inguinal herniorrhaphy were given spinal anaesthesia with hyperbaric 0.5% bupivacaine. In a randomized and blinded fashion half of them received an IINB 5 min before the surgical incision with 10 ml of 0.5% bupivacaine (B-IINB) and the other half with saline (S-IINB). All patients received ketoprofen 100 mg i.v. during surgery and another 100 mg 2-3 h postoperatively. The patients were observed for about 6 h in the day surgery unit before discharge. RESULTS: The results showed that in comparison with the S-IINB group, significantly fewer patients in the B-IINB group needed analgesics (P<0.01) and the amount required was also significantly less postoperatively, before discharge (about 6 h postoperatively) (P<0.05). The latency to the need for the first postoperative analgesic was shorter in the S-IINB patients (P<0.01). At home the VAS scores and the need for analgesics (oral ketoprofen 100 mg) were low with no differences between the groups. No complications occurred. CONCLUSION: It is concluded that no long-term analgesia could be demonstrated by a preincisional IINB performed during spinal anaesthesia in day-surgery inguinal herniorrhaphy patients. Thus, reduced analgesic requirement was seen only for about 6 h postoperatively.

Adult↗
PubMed1999

Effects of heptanol on the neurogenic and myogenic contractions of the guinea-pig vas deferens.

1. The effects of the putative gap junction uncoupler, 1-heptanol, on the neurogenic and myogenic contractile responses of guinea-pig vas deferens were studied in vitro. 2. Superfusion of 2.0 mM heptanol for 20-30 min produced the following reversible changes in the biphasic neurogenic contractile response (8 trials): (i) suppression of both phases; (ii) delayed development of both the first as well as the second phase, accompanied by complete temporal separation of the two phases; (iii) prominent oscillations of force during the second (noradrenergic) phase only. 3. To eliminate prejunctional effects of heptanol, myogenic contractions were evoked by field stimulation of the vas in the presence of suramin (200 microM) and prazosin (1 microM). Heptanol (2.0 mM) abolished these contractions reversibly. 4. These results show that (i) heptanol inhibits both excitatory junction potential (EJP)-dependent and non EJP-dependent contractions of the vas; (ii) a postjunctional site of action of heptanol, probably intercellular uncoupling of smooth muscle cells, contributes to the inhibition of contraction.

Adenosine Triphosphate↗
PubMed2003

Vardenafil enhances clitoral and vaginal blood flow responses to pelvic nerve stimulation in female dogs.

The relaxation of the smooth muscle in the vagina and clitoris and the increase of blood flow into these organs is thought to be essential in the female sexual response. Vardenafil is a type 5 phosphodiesterase (PDE5) inhibitor that potentiates the nitric oxide (NO)/cGMP pathway facilitating penile smooth muscle relaxation and improving penile erection in men. Although the potentiation of the NO/cGMP pathway through PDE5 inhibitors can clearly enhance blood flow into the penis and is used in the therapy of male sexual dysfunction, there is controversy about the efficacy of these agents in improving female sexual function. The aim of this work was to evaluate the effects of vardenafil on the increase of blood flow into the vagina and clitoris induced by pelvic nerve electrical stimulation (PNES) in a female dog model. Application of PNES produced consistent and frequency-related increased blood flow into the vagina and clitoris of anesthetized female dogs. The magnitude and duration of the blood flow responses to PNES were variable among the different animals but remained stable over time within the same animal. The intravenous administration of vardenafil (1 mg/kg) significantly potentiated the increases in blood flow produced by PNES into the vagina (381.4 and 206.2% of control response at 5 and 10 Hz, respectively, P<0.01, n=6) and clitoris (379.4 and 238.5% of control response at 5 and 10 Hz, respectively, P<0.01, n=6) 20 min after administration. The significant enhancement of PNES-induced responses was maintained 50 min (224.5 and 181.0%, P<0.01 in vagina; 294.8 and 258.9%, P<0.05 in clitoris) and 80 min after vardenafil administration (209.5 and 156.9%, P<0.05 in vagina; 268.9 and 194.9%, P<0.05 in clitoris). Here we present a feasible model for research into female sexual function. Our results show that vardenafil effectively potentiates the blood flow responses to PNES in the genitalia of female dogs. These results emphasize the role of the NO/cGMP pathway in the local vasodilatory response in female sexual organs and provide a rationale for testing PDE5 inhibitors, such as vardenafil, as a treatment for certain forms of female sexual dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2004

In vivo rat model to measure hypogastric nerve stimulation-induced seminal vesicle and vasal pressure responses simultaneously.

This study presents a modified in vivo model in which the intraluminal pressures of the seminal vesicle and vas deferens can be measured simultaneously. Male Sprague-Dawley rats were grouped based on agent administered: serotonin, clomipramine, fluoxetine, sertraline, paroxetine, prazosin, terazosin, and tamsulosin. The control responses to hypogastric nerve stimulation (HNS) were recorded in each animal, and HNS was repeated after each drug administration. Serotonergic agents resulted in concentration-dependent inhibition of the HNS-induced seminal vesicle pressure increases (clomipramine>serotonin>fluoxetine>sertraline approximately paroxetine). On the other hand, only serotonin and clomipramine significantly inhibited vasal pressure responses. alpha-Adrenergic blockers inhibited both intraluminal pressure responses in a concentration-dependent manner. This model illustrates the importance of the hypogastric nerve for the stimulation of the seminal tract, with attention focused on the seminal vesicle. This model may be useful for the evaluation of drugs for the treatment of premature ejaculation.

Animals↗
PubMed2003

Macro and microstructural organization of the dog's caudal mesenteric ganglion complex (Canis familiaris-Linnaeus, 1758).

The caudal mesenteric ganglion (CMG) is located ventral to the abdominal aorta involving the initial portion of the caudal mesenteric artery. Its macro and microstructural organization was studied in 40 domestic dogs. From the CMG, there were three nerves: the main hypogastric, the left hypogastric and the right hypogastric. The main hypogastric nerve emits two branches: the left colonic nerve and the cranial rectal nerve. Afterwards they give rise to branches to the descending colon (colonic nerves) and rectum (rectal nerves). The cranial rectal nerve, and left and right hypogastric nerves were directed to the pelvic ganglia. The microscopic study permitted the observation of the histological organization of the CMG, which is a ganglionic complex composed of an agglomeration of ganglionic units. Each ganglionic unit is composed of three major cell types: principal ganglion neurones (PGNs), glial cells and small intensely fluorescent (SIF) cells, and they were separated by nerve fibres, septa of connective tissue (types 1 and 3 collagen fibres), fibroblasts and intraganglionic capillaries. Hence, the ganglionic unit is the morphological support for the microstructural organization of the CMG complex. Further, each ganglionic unit is constituted by a cellular triad (SIF cells, PGN and glial cells), which is the cytological basis for each ganglionic unit.

Age Factors↗