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PubMed1977

[Complications of lumbar sympathectomy. Retrospective study of 791 patients].

The purpose of this paper is to define the nature and the frequency of post-lumbar sympathectomy complications and to reappreciate their importance in the evaluation of operative indication. The non specific miscellaneous complications are no more frequent than after any other lombotomy. The specific complications occur in less than 10%; they are almost always transient. Prolonged paralytic ileus is related to post-operative hematoma in retroperitoneal space. Ejaculation disturbances are produced either by bilateral resection of one of the two first lumbar ganglian or by section of the intermesenteric plexus, the presacral nerves or the hypogastric nerves during associated dissection of the aortic bifurcaiton. Late neuralgia is probably induced by retroperitoneal hematoma; its size increases gradually during the postoperative period by transference of tissue fluids. In conclusion, the morbidity and the morbidity rates of lumbar sympathectomy are remarkably low; these are not arguments against the lumbar sympathectomy.

Adult↗
PubMed1971

A study of the inferior mesenteric and pelvic ganglia of guinea-pigs with intracellular electrodes.

1. Ganglion cells in the inferior mesenteric ganglion (IMG) and the pelvic plexus of the guinea-pig were studied using intracellular micro-electrodes.2. Ganglion cells had resting membrane potentials of 55-65 mV. Threshold for initiation of an action potential ranged from 10 to 20 mV depolarization. Action potentials often exceeded 100 mV in amplitude and were followed by an after-hyperpolarization of up to 20 mV.3. Synaptic responses were recorded from cells in the IMG in response to stimulation of the right and left hypogastric nerves, ascending mesenteric, inferior splanchnic and colonic nerves. It has been established that more than forty preganglionic fibres converge on any one cell. Preganglionic fibres to the IMG were also observed in the pelvic nerves.4. In contrast to the IMG, ganglion cells in the pelvic plexus received up to ten preganglionic fibres.5. Ganglion cells responded to supramaximal preganglionic stimulation with up to four action potentials.6. In the IMG, action potentials in response to synaptic action were followed by a prolonged period of hyperpolarization (after-hyperpolarization) and a later phase of prolonged depolarization (after-depolarization). The time course of these after potentials depended on the pattern of firing of action potentials during the period of stimulation. In the presence of dihydro-beta-erythroidine, or if synaptic action was insufficient to evoke action potentials, only the after-depolarization was observed.7. Other cells were impaled whose properties differed from those described above. In one group of cells the resting membrane potentials were higher (up to 85 mV), input resistances lower and the threshold for initiation of an action potential was higher. The other group were inexcitable, had high resting membrane potentials (up to 85 mV), low input resistances and underwent a slow depolarization in response to repetitive stimulation of preganglionic fibres.8. This study indicates that marked convergence of presynaptic fibres occurs on to ganglion cells of the IMG. The ganglion cells in the pelvic plexus receive a relatively small number of fibres, many of which exert intense synaptic activity ensuring a direct connexion to the central nervous system.

Action Potentials↗
PubMed1996

Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome.

BACKGROUND: Serious problems in the surgical treatment of patients with rectal carcinoma are local failure and urinary and sexual dysfunction. To resolve these problems, pelvic autonomic nerve preservation (PANP) combined with lateral lymph note dissection has been introduced. METHODS: Of 238 consecutive patients with middle or low rectal carcinoma who underwent potentially curative surgery between 1987 and 1992, 214 underwent PANP according to pre- and intraoperative staging. PANP was evaluated from the perspectives of oncologic outcome and urinary and male sexual function with a retrospective questionnaire in a group of patients followed prospectively. RESULTS: During the median follow-up of 53 months, local recurrence developed in 5.6% of patients; no local recurrence was observed in Dukes Stage A or Dukes Stage B patients. The 5-year survival rates of Dukes Stage A (n = 55), Dukes Stage B (n = 72), and Dukes Stage C (n = 87) patients were 96.4%, 84%, and 67.3%, respectively. Of patients undergoing preservation of the unilateral pelvic plexus alone, 93.5% maintained the ability to void spontaneously. Of patients who had complete preservation of the autonomic nerve system, 70.4% maintained male sexual function, and of patients who had removal of the hypogastric nerves and preservation of the pelvic nerve plexuses, 66.7%, were capable of erection and intercourse without normal ejaculation. CONCLUSIONS: Early stage rectal carcinoma should be treated both with local cure and complete preservation of urinary and sexual function. In high risk patients with suspected perirectal lymph node metastases and tumors invading the perirectal fat, the appropriate PANP should be applied with consideration of the balance between achieving a cure and preserving autonomic function.

Adult↗
PubMed1981

Dorsolumbosacral phlebography.

Two variations on the currently most commonly used technical method for phlebography are described. The first variation involves an original method for visualizing the dorsolumbosacral epidural plexus via the retrograde route from the azygos vein. If necessary this can be associated with catheterization and simultaneous injection into an ascending lumbar vein or into a lateral sacral vein. This method permits exploration from T7 to S1 and provides phlebograms of excellent quality, owing to the reduction in the flow caused by countercurrent injection. The second variation involves visualizing the epidural venous plexus by means of double percutaneous transfemoral catheterization of the hypogastric veins, using balloon catheters. This method is performed easily and rapidly. Preferential flow is obtained via the epidural plexus, and there is less diversion of the contrast medium through anastomoses and less filling of the vena cava. The specific indications for these methods are described. The availability of alternative methods beyond the traditional one renders epidural phlebography more reliable and more manageable, and it ensures certainty of diagnosis.

Azygos Vein↗
PubMed1995

Innervation of the smooth muscle of the lower urinary tract.

The lower urinary tract in mammals consists of the bladder, a storage organ for urine, and the urethra through which urine is expelled to the outside. In the male the urethra extends outside the body as the penis. The lower urinary tract is innervated by pelvic (parasympathetic) nerves and hypogastric nerves which combine on each side at the pelvic plexus. Fibres pass to the bladder, urethra, genital organs, rectum and blood vessels. In addition to the pelvic and hypogastric nerves there is sacral outflow to skeletal muscle, such as the external sphincters of the urethra and anus, in the pudendal nerve and the sympathetic chain extends caudally with branches lying in the sacral outflow that supply the penis and other organs though not the bladder. Bladder evacuation and penile erection are produced by activity of the pelvic nerves whereas sympathetic activity usually dominates during urine storage and penile flaccidity, though it may not be essential for either.

Animals↗
PubMed1997

Neuronal circuitry between the inferior mesenteric ganglion and lower intestine of the dog.

Neuronal circuitry between the inferior mesenteric ganglion (IMG) and the distal colon as well as the rectum, forming the intestino-intestinal reflex pathway, was investigated in the dog using immunohistochemistry combined with retrograde tract tracing and denervation experiments. Virtually all IMG neurons were tyrosine hydroxylase (TH)-immunoreactive. Of these ganglionic neurons, about 64% were also immunoreactive for calbindin (Calb), some 35% for neuropeptide Y (NPY), and 2% for vasoactive intestinal peptide (VIP). The retrograde tracer experiments revealed that both Calb/TH neurons and NPY/TH neurons projected to the distal colon and the rectum. In these intestinal walls, Calb/TH positive varicose fibers were found in the myenteric and submucous ganglia as well as in the longitudinal muscle layer, while NPY/TH positive fibers were mainly distributed around the vascular walls. Around Calb/TH neurons of the IMG, abundant varicose nerve fibers immunoreactive for VIP, dynorphin (DYN), calcitonin gene-related peptide (CGRP), enkephalin (ENK), substance P (SP) and bombesin (BOM) were distributed. These immunoreactive fibers disappeared after the total denervation of the IMG. After the application of Fast Blue into the IMG or distal stumps of transected lumbar colonic and hypogastric nerves, retrogradely labeled neurons occurred in the myenteric plexus with increasing density along the distal colon and rectum, and were immunoreactive for VIP, DYN, CGRP, ENK, SP or BOM. Double immunostaining of nerve fibers in the distal stumps of the ligated colonic and hypogastric nerves revealed the presence of viscerofugal fibers containing VIP with DYN and/or CGRP and those containing ENK with SP and/or BOM. These results demonstrate for the first time that the efferent limb of the canine intestino-intestinal reflex arch via the IMG consists of Calb-immunoreactive ganglion neurons projecting to the longitudinal muscles in addition to the enteric plexus of the lower intestine and also of NPY-immunoreactive ganglion neurons projecting to the intestinal blood vessels, and that the afferent limb is composed of at least two discrete groups with different peptide contents, i.e., myenteric neurons containing VIP with DYN and/or CGRP and those containing ENK with SP and/or BOM.

Animals↗
PubMedDate not supplied

A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function.

The objective of this study is to describe a technique for preserving the autonomic nerve systematically, including the hypogastric nerves, pelvic splanchnic nerves, and pelvic plexus and its vesical branches, based on anatomic considerations for the autonomic nerves innervating the urinary bladder, in radical hysterectomies and to assess postsurgical bladder function. A nerve-sparing radical hysterectomy was carried out on 27 consecutive patients with uterine cervical cancer treated between 2000 and 2002. The FIGO stages of the disease consisted of 10 stage Ib1, 6 stage Ib2, 3 stage IIa, and 8 stage IIb. The nerve-sparing procedure was successfully completed in 22 of the 27 patients (81.5%) in the study. At 1 year after the operation, bladder symptoms were significantly improved in the nerve-sparing group compared to the non-nerve-sparing group. Urinary incontinence and abnormal (diminished) bladder sensation were observed in three of the five patients (two patients had both symptoms), for whom the nerve-sparing procedure could not be performed, but none of the 22 patients for whom the nerve-sparing procedure was performed had incontinence, and only two patients had abnormal (increased) bladder sensation (P= 0.0034 for incontinence and P= 0.030 for abnormal bladder sensation). The patients' survival was not adversely affected by the nerve-sparing procedure. Although it is still preliminary, the surgical technique described in this report is thought to be effective for preserving bladder function, and thus, the quality of life could be improved for patients with cervical cancer who are treated with a radical hysterectomy. For further evaluation of the efficacy of nerve-sparing radical hysterectomy, a prospective randomized trial needs to be performed.

Adenocarcinoma↗
PubMed2001

Spontaneous reconstruction of the canine hypogastric nerve over a long period after removing half of its length.

Spontaneous reconstruction of the sympathetic pathway projecting to the seminal tract after serious injury has not been well understood. Multiple cross-innervation mechanisms from the spinal cord via the hypogastric nerve to the seminal tract have been demonstrated currently. This study was undertaken to explore long-term spontaneous reconstruction of the canine hypogastric nerve (HGN), which controls ejaculation, after removing half of its length. Further, the study tried to identify the crossed-pathway(s) reconstructed. Responses of the vas deferens/epididymis and bladder neck to electrical stimulation of the lumbar splanchnic nerve (LSN) or the HGN were examined. In six dogs whose hypogastric nerve was injured bilaterally as described above 4 years before, corresponding to more than 20 years in human, nine (43%) and 13 (57%) of the 21 LSNs stimulated elicited elevation of vasal and bladder neck pressure, respectively. By combining re-transection of a HGN, the following pathways to the vas deferens/epididymis were identified to have been reconstructed: (1) to the ipsilateral was deferens/epididymis without crossing to the other side; (2) to the contralateral vas deferens/epididymis by crossing to the other side at the caudal mesenteric plexus (CMP); (3) to the contralateral vas deferens/epididymis by crossing to the other side from the ipsilateral HGN at the commissural branches between the right and left pelvic plexuses (CBPP); and (4) to the ipsilateral vas deferens/epididymis by crossing twice at the CMP to the other side and at the CBPP again from the contralateral HGN to the ipsilateral side. The similar patterns of reconstruction were also observed in the bladder neck. The above results indicate that the sympathetic pathways via the HGN to the canine seminal tract can be reconstructed spontaneously in a high rate over a long period after serious injuries and that their cross-innervation system can be repaired.

Animals↗
PubMed1993

The effect of chronic decentralization on the enkephalin immunoreactive plexus around penile ganglionic neurons.

Target organ responses to sympathetic nerve stimulation are altered following partial decentralization of the pelvic plexus in the rat. One possible explanation for the new responses is that nerve injury has led to a reorganization of synaptic connections within pelvic ganglia. Since one measure of synaptic influence is the occurrence of a pericellular plexus of varicose fibers around autonomic ganglion cells, the present study has used immunocytochemistry for enkephalin (ENK), a peptide present in nerve fibers in the pelvic plexus, to follow changes in the innervation of penile ganglionic neurons after interruption of preganglionic pathways. Penile ganglion cells were located by the injection of the tracer Fluorogold into the penile crura. Four days after lesion of the pelvic nerve, innervation of penile neurons falls from 76% to 20%. This number increases however, to 31% in chronically (6 weeks) lesioned animals. In the totally decentralized ganglia, ENK immunoreactive (IR) fibers enclose fewer than 12% of the penile neurons 4 days after nerve lesion. However, this value rises to 35% in the chronically decentralized pelvic ganglion. Therefore, recovery of an enkephalin plexus occurs irrespective of whether the pelvic nerve, or both the hypogastric and pelvic nerve have been cut. Although these findings suggest sprouting within partially decentralized ganglia, the similar incidence of an ENK plexus in ganglia subjected to chronic partial or total decentralization indicates that preganglionic fibers are not responsible for the emergent fibers.

Animals↗
PubMed1977

Light and electron microscopic studies on the intrinsic innervation of the guinea-pig seminal vesicle following selective axotomy.

Selected peripheral autonomic nerves have been surgically divided or removed and the seminal vesicles subsequently examined using neurohistochemical and electron microscopic techniques. Following bilateral hypogastric anf pelvic nerve transection, the arrangement and distribution of intramural axons 14 days after operation were similar to those in control specimens. In contrast, removal of the pelvic plexus was accompanied by a gradual reduction of catecholamine and acetylcholinesterase so that by the seventh post-operative day nerves were not observed light microscopically in the muscle coat or the submucosa. These observations have been endorsed using electron microscopy, and the fine structure of intramural autonomic nerves in response to axotomy has been monitored during the post-operative period. It has been concluded that the cell bodies of axons which supply the wall of the seminal vesicles are located within the pelvic plexus and do not extend proximal to the sites of division of the hypogastric and pelvic nerves.

Acetylcholinesterase↗
PubMed1991

Neurally evoked potentiation of tonic contractions in the guinea-pig vas deferens involves adenosine receptors.

1. In the pelvic plexus-vas deferens preparation of the guinea-pig, conditioning stimulation of the pelvic nerves depressed the phasic component of biphasic contractions evoked by test stimulation of the hypogastric nerves, but potentiated the tonic component. 2. Similarly, in the deganglionated vas deferens preparation, conditioning stimulation applied directly to postganglionic nerves issuing from the pelvic nerve side of the pelvic plexus depressed the phasic component of biphasic contractions evoked by test stimulation of the nerves issuing from the plexus on the side of the hypogastric nerve, but potentiated the tonic component. 3. In the deganglionated preparation in the presence of alpha,beta-methylene adenosine 5'-triphosphate (alpha,beta-mATP) by which the phasic component was removed, test contractions were markedly reduced by phentolamine and prazosin, and potentiated in a manner dependent on the magnitude of conditioning stimulation. 4. In the deganglionated preparations that were persistently exposed to alpha,beta-mATP (5-10 microM), attempts were made to identify the substance(s) mediating the potentiation of the prazosin-sensitive contractions and their sites of action. 5. Noradrenaline and neuropeptide Y depressed the test contractions. 6. ATP, adenosine 5'-diphosphate, adenosine 5'-monophosphate and adenosine potentiated the contractions. Inosine and adenine were without effect. The effect of ATP was antagonized by 8-phenyltheophylline. N6-Cyclohexyladenosine (CHA) potentiated the contractions in a dose-dependent and 8-phenyltheophylline-sensitive manner. 7. The conditioning stimulation-induced potentiation of test contractions was antagonized by 8-phenyltheophylline, but was further increased by dipyridamole. 8. Methoxamine-evoked contractions were potentiated by conditioning stimulation of the nerves in a manner antagonized by 8-phenyltheophylline, and also by CHA. 9. Adenosine and CHA inhibited in an 8-phenyltheophylline-sensitive manner field stimulation-induced release of 3H-activity from deganglionated vas deferens preloaded with [3H]noradrenaline. 10. In the deganglionated preparation that was not exposed to alpha, beta-mATP, ATP-evoked contractions were potentiated by conditioning stimulation and by CHA. 11. It is indicated that conditioning stimulation and adenosine exert opposite actions on phasic and on tonic contractions in spite of the results showing that each of them postjunctionally potentiates the responses to both ATP and noradrenaline. 12. These results suggest that conditioning stimulation releases adenosine and that adenosine potentiates tonic contractions by increasing the responsiveness of the muscle to noradrenaline through the postjunctional adenosine receptors.

Adenosine↗
PubMed1995

Distribution and morphological characterization of viscerofugal projections from the large intestine to the inferior mesenteric and pelvic ganglia of the male rat.

Viscerofugal neurons are enteric neurons in the myenteric plexus of the stomach and intestine that project to the prevertebral ganglia as the afferent limb of intestino-intestinal reflexes. This study characterizes viscerofugal projections to the inferior mesenteric ganglion and investigates the possibility of similar projections to the major pelvic ganglia in the male rat. The colon and rectum were examined for retrogradely labelled neurons following the injection of retrograde tracer into the inferior mesenteric or major pelvic ganglia, or following the application of tracer to the caudal end of the cut intermesenteric nerves, or either end of the cut hypogastric nerves. All labelled viscerofugal neurons were found in the myenteric plexus and were often grouped near the mesenteric attachment. The number of viscerofugal neurons projecting to the inferior mesenteric ganglion via the lumbar colonic nerves increases along the length of the large intestine with the maximum number of viscerofugal neurons found in the rectum. Some viscerofugal neurons from the distal colon and rectum reach the inferior mesenteric ganglion via the hypogastric nerves. A similar number and distribution of viscerofugal neurons project via the inferior mesenteric ganglion into the intermesenteric nerves as terminate in the inferior mesenteric ganglion. Very few viscerofugal neurons project to the neurons of the major pelvic ganglia via the rectal nerves, and no viscerofugal neurons project caudally in the hypogastric nerves to these ganglia. The majority of labelled neurons resembled Dogiel type I morphology. Thus the inferior mesenteric ganglion receives a substantial innervation from viscerofugal neurons of the large intestine, with the greatest supply from the distal colon and rectum.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Parasympathetic depression of vas deferens contraction in the guinea-pig involves adenosine receptors.

1. In the guinea-pig pelvic plexus-vas deferens preparation, stimulation of the parasympathetic pelvic nerves contracted the vas deferens then depressed the contractile responses to stimulation of the sympathetic hypogastric nerves. 2. The contraction caused by stimulation of the pelvic nerves was initially phasic then tonic. The contractions were almost abolished by application of hexamethonium to the plexus. The phasic contraction was abolished by alpha,beta-methylene adenosine triphosphate applied to the vas deferens. 3. Conditioning stimulation of the pelvic nerves preferentially depressed the phasic component of test contractions evoked by hypogastric nerve stimulation but did not affect the compound action potentials in postganglionic nerves evoked by test stimulation. 4. When the pelvic plexus was divided into two parts, one with the pelvic nerves and the other with the hypogastric nerves, conditioning stimulation of the pelvic nerves still depressed test contractions evoked by hypogastric nerve stimulation. 5. In the de-ganglionated vas deferens preparation, conditioning stimulation of some postganglionic nerves also depressed contractions evoked by test stimulation of the other postganglionic nerves. 6. 8-Phenyltheophylline (5-20 microM) applied to the vas deferens antagonized the conditioning stimulation-induced depression in both the pelvic plexus-vas deferens and the de-ganglionated preparations. 7. N6-Cyclohexyladenosine (CHA) and N6-(L-2-phenylisopropyl)-adenosine at 0.5 microM preferentially inhibited phasic contractions evoked by the postganglionic nerve stimulation. The effect of CHA was antagonized by 8-phenyltheophylline (10 microM). 8. The results indicate that the mechanism underlying the conditioning stimulation-induced depression of phasic contractions operates not in the ganglia, but through activation of adenosine receptors in the vas deferens.

Action Potentials↗
PubMed2003

Fascial structures and autonomic nerves in the female pelvis: a study using macroscopic slices and their corresponding histology.

We investigated the topographical anatomy of the pelvic fasciae and autonomic nerves using macroscopic slices of five decalcified female pelves. The lateral aspect of the supravaginal cervix uteri and superior-most vagina issued abundant thick fiber bundles. These visceral fibrous tissues extended dorsolaterally, joined another fibrous tissue from the rectum (the actual lateral ligament of the rectum) and attached to the parietal fibrous tissues at and around the sciatic foramina (i.e. the sacrospinous ligament, thick fasciae of the coccygeus and piriformis and dorsal end of the covering fascia of the levator ani). The inferior or ventral vagina also issued thick fiber bundles communicating with the levator ani fascia. This connection between the vagina and levator fascia, when stretched, seemed to provide a macroscopic morphology called the arcus tendineus fasciae pelvis. The overall morphology of the visceroparietal fascial bridge exhibited a bilateral wing-like shape. The fascial bridge complex was adjacent but dorso-inferior to the internal iliac vascular sheath and located slightly ventral to the pelvic splanchnic nerve. However, the pelvic plexus and its peripheral branches were embedded in the fascial complex. The hypogastric nerve ran along and beneath the uterosacral peritoneal fold, which did not contain thick fibrous tissue. During surgery, in combination with the superficially located vascular sheath, the morphology of the visceroparietal fascial bridge and associated nerves seemed to be artificially changed and developed into the so-called cardinal, uterosacral, uterovesical and/or rectal lateral ligaments. The classical and original concepts of these pelvic fascial structures may need to be altered to adjust to these surgical observations.

Aged↗
PubMed1998

[Substantiation of the use of implantation method in surgical reinnervation of kidney transplant].

New operative method of surgical reinnervation of transplanted kidney was elaborated, experimentally substantiated on 39 mongrel dogs and used in 26 recipients of allonephrotransplants in three transplantation centres. The efficacy and security for recipient of the proposed combined implantation in sinus of transplanted kidney of atraumatically mobilized iliac vegetative plexuses consisting of fascia-adventitia strip-like flaps and lower hypogastric nerves of recipient zone with the neuroterminals preserved was noted. The method may be used independently and in combination with method of nephrogangliotransplantation.

Animals↗