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At least 541 records · Page 30Linked to original sources
PubMed2000

Anorectal and bladder function after sacrifice of the sacral nerves.

STUDY DESIGN: The quantitative changes in anorectal and bladder functions after sacrifice of the sacral nerves were assessed. OBJECTIVES: To evaluate the bladder and anorectal functions before and after sacral nerve division in patients with sacral bone tumors. SUMMARY OF BACKGROUND DATA: The quantitative changes in bladder and anorectal functions after sacrifice of the sacral nerves have not been intensively studied. The purpose of this investigation was to measure the bladder and anorectal function before and after sacral nerve division using manometry and cystometry. METHODS: Surgical resection of a sacral tumor was performed in five patients. The sacral nerves were sacrificed bilaterally in three patients and unilaterally in two patients. Anorectal function was evaluated on the basis of symptoms and physiologic tests. Micturition function was evaluated based on symptoms, and intravesical pressures were measured by cystometry. RESULTS: The two patients with unilateral sacral nerve loss did not experience subjective problems with defecation or micturition, although the residual volume of urine was increased after surgery. Two of the three patients with bilateral sacral nerve loss had no urge to defecate, were unable to differentiate between feces and flatus, and experienced no urgency. Fecal incontinence was uncommon because of firm feces. It was possible to control defecation using enemas on alternate days. The third patient underwent colostomy because the maximum resting pressure, which is controlled by the hypogastric nerves, was affected before surgery. CONCLUSION: Unilateral sacrifice of sacral nerves results in little bladder or anorectal dysfunction.

Adult↗
PubMed1997

Occult obstetric trauma and anal incontinence.

Obstetric trauma is by far the commonest cause of anal incontinence in women. Denervation and reinnervation of the pelvic floor and anal sphincter following vaginal delivery has been previously demonstrated. The advent of anal endosonography, however, has enabled the identification of occult anal sphincter defects following vaginal delivery. It is now possible to identify risk factors and change obstetric practice accordingly so as to minimize anorectal morbidity.

Anal Canal↗
PubMed2006

Innervation of the pelvic floor muscles: a reappraisal for the levator ani nerve.

OBJECTIVE: We investigated the clinical anatomy of the levator ani nerve and its topographical relationship with the pudendal nerve. METHODS: Ten female pelves were dissected and a pudendal nerve blockade was simulated. The course of the levator ani nerve and pudendal nerve was described quantitatively. The anatomical data were verified using (immuno-)histochemically stained sections of human fetal pelves. RESULTS: The levator ani nerve approaches the pelvic-floor muscles on their visceral side. Near the ischial spine, the levator ani nerve and the pudendal nerve lie above and below the levator ani muscle, respectively, at a distance of approximately 6 mm from each other. The median distance between the levator ani nerve and the point of entry of the pudendal blockade needle into the levator ani muscle was only 5 mm. CONCLUSION: The levator ani nerve and the pudendal nerve are so close at the level of the ischial spine that a transvaginal "pudendal nerve blockade" would, in all probability, block both nerves simultaneously. The clinical anatomy of the levator ani nerve is such that it is prone to damage during complicated vaginal childbirth and surgical interventions.

Cadaver↗
PubMed2003

Hydrochloric acid induced changes in macrophage migration inhibitory factor in the bladder, peripheral and central nervous system of the rat.

PURPOSE: We established the presence of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) in the bladder and in nervous system structures innervating the bladder, and evaluated changes in MIF and cyclooxygenase-2 (COX-2) protein levels and expression following chemical cystitis. MATERIALS AND METHODS: Male Sprague-Dawley rats were anesthetized and a catheter was introduced into the bladder dome. Cystitis was induced by infusing 0.4 N HCl into the bladder. Control rats received a similar volume of saline. Two hours later the bladder, major pelvic ganglia (MPG), L6/S1 dorsal root ganglia (DRG) and L6/S1 spinal cord were removed and assayed for MIF and COX-2 protein, and mRNA using Western blot and quantitative reverse transcriptase-polymerase chain reaction techniques. RESULTS: Immunohistochemistry showed MIF located mainly in the urothelium of saline treated rats. Instillation of HCl into the bladder resulted in marked epithelial denudation, moderate edema and vasodilatation in the submucosa. MIF protein levels decreased but MIF mRNA expression remained unchanged in bladders treated with HCl compared with controls. However, MIF protein and mRNA levels increased in the MPG, L6/S1 DRG and L6/S1 spinal cord of HCl treated animals. COX-2 protein was not detected in the bladder, DRG or MPG of saline-treated rats. However, a small amount was present in the L6/S1 cord. On the other hand, HCl treated rats showed marked increases in COX-2 protein levels in all tissues examined. Similarly although cox-2 mRNA was constitutively expressed in all tissues examined, expression increased following HCl treatment. CONCLUSIONS: Chemical cystitis induced by intravesical HCl in rats increases the protein levels and mRNA expression of MIF and COX-2 in central and peripheral nervous system tissues that are involved in innervating the bladder. This finding suggests that MIF may be involved in bladder inflammation and may have a role in the peripheral and central nervous system pathways that regulate bladder reflexes in response to bladder inflammation.

Animals↗
PubMed2004

Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy.

PURPOSE: Urologists and anatomists have disagreed concerning pelvic neurovascular bundle (NVB) structure. Recently interposition nerve grafting has been performed to improve erectile function after radical prostatectomy. To refine this procedure we reviewed NVB structure from the surgical viewpoint. MATERIALS AND METHODS: Seven fresh cadavers and serial horizontal sections from 20 formalin fixed cadavers were used for gross dissection and histological examination. RESULTS: Fresh cadaver dissections demonstrated that the pelvic splanchnic nerve (PSN) joined the NVB at a point distal or inferior to the bladder-prostate (BP) junction. Histologically hypogastric nerve fibers were much more dominant than PSN fibers at the BP junction, and the NVB, covered by the lateral pelvic fascia, became evident at levels more than 20 to 30 mm below the BP junction. PSN components joined the NVB in a spray-like distribution at multiple levels more than 20 mm distal to the BP junction. At these low levels nerves tended to be located outside of the NVB at the dorsolateral margin of the prostate. The cranial end of the mimic interposition nerve graft was directed toward the hypogastric nerve rather than the PSN. CONCLUSIONS: In contrast to general clinical opinion, the NVB appears to supply few PSN components at the BP junction with caudal PSN branches reaching the dorsolateral prostate more than 20 mm below the BP junction. This anatomy has important implications for a reliable nerve graft.

Aged↗
PubMed2006

The effects of cavernous nerve grafting following surgically induced loss of erectile function in a large-animal model.

BACKGROUND: Prostate cancer is the second most common cause of cancer deaths in men in the United States. Many patients experience partial or complete loss of erectile function following prostatectomy. The cavernous nerves can be reconstructed intraoperatively using sural nerve grafts in an attempt to restore erectile function. METHODS: In this study, multiple anatomical dissections and neurologic assessments were used to define the position and histologic parameters of the cavernous nerve in a canine model. The subsequent experimental design included three groups of adult mongrel dogs followed for an 8-month period. Group 1, the control group, underwent bilateral nerve ablation to substantiate surgically induced loss of erectile function. Group 2, the "sham" group, underwent exploration only. Group 3 underwent bilateral cavernous nerve ablation with bilateral sural nerve graft reconstruction. Erectile function was evaluated with indirect electrical nerve and manual penile stimulation preoperatively and 1, 2, 4, 6, and 8 months postoperatively. Direct nerve stimulation and histologic analysis was preformed at the first operation and at the time the animals were euthanized at 8 months. RESULTS: Bilateral cavernous nerve ablation resulted in a significant loss of erectile function for 8 months postoperatively in the control animals. The sham animals demonstrated preservation of erectile function immediately following exploration. The animals in the grafted group demonstrated a significant return of erectile function by 4 months compared with preoperative measurements and by 2 months compared with control animals. CONCLUSIONS: This study establishes the first large-animal model for surgically induced loss of erectile function with successful cavernous nerve graft reconstruction, and it provides the unique opportunity to explore the effects of changes to this model in the future.

Animals↗
PubMed2006

Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy.

OBJECTIVE: This study was carried out to determine the optimal anesthetic technique for use in elective herniorrhaphy. METHODS: We retrospectively analyzed 126 inguinal hernia repairs. The patients were allocated to one of two groups: an ilioinguinal-iliohypogastric nerve block group (IHNB group, n = 63) and spinal anesthesia group (SA group, n = 63). We recorded information about perioperative and postoperative parameters. RESULTS: There were statistically significant decreases in both mean arterial pressure and pulse rate in the SA group (P < 0.001). None of the patients in the IHNB group required recovery room care. Patients in the IHNB group initiated oral intake (0.31 +/- 0.1 h) more quickly than patients in the SA group (5.74 +/- 0.1 h) (P < 0.001). The time-to-home readiness was significantly lower (14.1 +/- 1.5h) in group IHNB, compared with group SA (42.8 +/- 5.3h) (P < 0.001). First rescue analgesic time postoperatively was 3.30 +/- 0.2 hours in group SA and 2.7 +/- 0.13 hours in group IHNB (P < 0.05). CONCLUSION: The use of IHNB for patients undergoing herniorrhaphy resulted in a shorter time-to-home readiness, quicker oral intake post surgery, and no need for recovery room care, when compared with the use of SA.

Adult↗
PubMed2004

Nitric oxide as putative second messenger in nerve-induced cervical gland secretion in the guinea-pig.

Uterine cervical secretory cells receive a sympathetic cholinergic secretomotor innervation. It has been suggested that glandular nitric oxide (NO) production is a prerequisite for muscarinic-induced carbohydrate secretion in the endometrium and the seminal vesicle. A similar pattern for nerve-induced carbohydrate secretion in the cervix could be assumed. Nitric oxide synthase (NOS) activity was evaluated via formation of L-citrulline from L-arginine. The NADPH-diaphorase nitroblue technique was used for histochemical investigation. The cervix with the adjacent hypogastric nerve was placed in an isolated organ bath and the secretion was evaluated as an amount of carbohydrate. A calcium-dependent formation of citrulline was found in the cervix indicating NO formation. Strong NADPH-staining cells were found in the glandular ducts and in the glandular linings of the cervix. Stimulation of the hypogastric nerve induced carbohydrate secretion, which was inhibited by N-nitro-L-arginine methyl ester (L-NAME). D-NAME did not affect the secretory response. Carbachol and the NO donor glyceryl trinitrate (GTN) induced carbohydrate secretion in the cervical glands. No synergistic effect was noted probably due to an all-or-none type of secretion. N-nitro-L-arginine (L-NNA) and L-NAME inhibited carbachol-induced secretion. The results suggest that glandular NO production is a prerequisite for the autonomic nervous modulation of cervical secretion in the guinea-pig. This could have implications regarding fertility and fecundity.

Animals↗
PubMed1979

Aminoglycoside antibiotics and sympathetic ganglionic transmission.

The effects of streptomycin, gentamicin, tobramycin and amikacin on transmission in sympathetic ganglia have been studied using the guinea pig isolated hypogastric nerve-vas deferens preparation. These aminoglycoside antibiotics produce dose-related sympathetic blockade at concentrations greater than the common therapeutically effective antibiotic concentrations.

Aminoglycosides↗
PubMed2006

Ano-rectal motility responses to pelvic, hypogastric and pudendal nerve stimulation in the Göttingen minipig.

UNLABELLED: We investigated the effect of efferent stimulation of the pelvic (PN), hypogastric (HGN) and pudendal (PuN) nerves on ano-rectal motility in Göttingen minipigs using an impedance planimetry probe. Changes in the rectal cross-sectional area (CSA) at five axial positions and pressures in the rectum and anal canal were investigated simultaneously. Pelvic nerve stimulation elicited a CSA decrease in the proximal part of the rectum and a simultaneous CSA increase in its distal part. Anal pressure also decreased. Hypogastric nerve and PuN stimulation elicited an increase in anal pressure, but no rectal response. Severing the HGN produced a persistent reduction in resting anal pressure, but no change was observed when the PN and the PuN were severed. Stimulation of the distal part of all three nerves produced a persistent response. Administration of phentolamine and pancouronium eliminated the response to stimulation of the HGN and the PuN, respectively. CONCLUSION: Rectal responses to PN stimulation vary more than previously suggested. The HGN has an excitatory effect on the internal anal sphincter, and the PuN on the external anal sphincter. However, the PuN plays no major role in maintaining basal anal pressure.

Anal Canal↗
PubMed1981

Disopyramide anticholinergic action.

The effect of disopyramide on cholinergic transmission has been studied using the frog isolated abdominis rectus preparation and the guinea pig isolated vas deferens hypogastric nerve preparation. Disopyramide (2 X 10(-5) mol litre-1) reduced the response of the abdominis rectus to carbachol (1.36 X 10(-6)--4.8 X 10(-5) mol litre-1). Furthermore, disopyramide (1 X 10(-6)--3 X 10(-4) mol litre-1) produced a concentration-dependent reduction in the response to carbachol (5.46 X 10(-6) mol litre-1). The response to potassium chloride (3.34 X 10(-2) mol litre-1) was unaltered by disopyramide (1 X 10(-6)--3 X 10(-4) mol litre-1). Disopyramide produced a dose-related ganglionic blockade at concentrations greater than 2 X 10(-5) mol litre-1. Complete blockade to ganglionic transmission occurred at 3 X 10(-4) mol litre-1 disopyramide.

Abdominal Muscles↗
PubMed2006

Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in children.

BACKGROUND: Three different sites of needle insertion have been proposed for ilioinguinal-iliohypogastric (ILIH) nerve block. This double-blind study was designed to assess the quality of analgesia produced from these different sites. METHODS: One hundred and thirty-two children of ASA grade I and II were randomly allocated into four groups to receive no nerve block (control group, n = 30) or ILIH block at 1 cm inferio-medial to the anterior superior iliac spine (ASIS) in group IM (n = 34), 1-2 cm medial to the ASIS in group M (n = 34) and 2 cm superio-medial to the ASIS in group SM (n = 34) with 0.25 ml/kg of 0.25% bupivacaine after induction of anaesthesia. Pain was assessed using the All India Institute of Medical Sciences (AIIMS) pain discomfort scale (APDS) score. The amount and pattern of fentanyl consumed over the ensuing 24-h period was noted. RESULTS: APDS score and fentanyl requirement were similar in all the study groups but significantly higher until 8 h after surgery in the control group, P < 0.05. Twenty-two out of 102 children in the study groups and all patients in the control group received additional fentanyl during the post-operative period. Only 6 out of 22 children required additional fentanyl supplementation beyond the 30-min interval. Overall failure rate of ILIH nerve block was 6%. CONCLUSION: ILIH block can be successfully accomplished from any point if the needle bevel lies between the two muscle planes above and below the internal oblique.

Analgesics, Opioid↗
PubMed1975

On the transportation of spermatozoa in the vas deferens.

In this report the intraluminal pressure of the vas deferens was measured in vivo in male cross-bred dogs. The measurement of the pressure elucidated that the vas deferens repeated autonomic contraction. This contraction was not the so-called peristalsis but the entire portion of the vas deferens contracted simultaneously. Stimulation of the hypogastric nerves resulted in a prominent elevation of the pressure in the proximal portion of the vas deferens, i.e., the portion approximate to the epididymis, followed 5-10 seconds later by a rise in the distal portion, i.e., the portion approximate to the prostate. These results suggest that the spermatozoa present near the proximal end of the vas deferens are transported littly by little by the autonomic movements of the vas deferens and that on ejaculation the spermatozoa are pressed forward from the proximal end of the vas deferens to its peripheral end by the stimuli through the hypogastric nerves.

Animals↗