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PubMed1982

Urethral pressure profiles following radical hysterectomy.

Urethral function following radical hysterectomy was studied by chronologic analysis of the urethral pressure profile. Thirty patients who had radical hysterectomy were divided into 2 groups according to the degree of preservation of the plexus pelvicus at operation. The method of complete preservation is described. Urethral pressure profiles showed a significant postoperative decrease of mean maximum urethral closure pressure in the group of 20 patients with bilateral nerve transection; this was not found in the group of 10 patients with complete preservation of the plexus pelvicus. The decrease was ascribed to possible damage of sympathetic nerves originating from the hypogastric nerve. The results indicated that postoperative abnormalities in urination are caused by damage not only to the parasympathetic nerves (the pelvis nerve) but to the sympathetic nerves (the hypogastric nerve) as well.

Female↗

PubMed1995

[Assessment of disturbance of urinary bladder function after an operation for rectal cancer].

Disturbance of urinary bladder function occurs frequently after operations on rectal cancer. Clinical studies of 15 male patients with resected rectal cancers revealed a close relationship between the disturbance of urinary bladder function and the extent to which the autonomic nerves in the pelvis were disturbed. Clinically, transection of the hypogastric nerve did not affect urinary function. Branches to the urinary bladder in the pelvic plexus controlled bladder function bilaterally. Transection of one side of the pelvic splanchnic nerve (PSN) did not affect bladder function. Partial transection of the bilateral PSN strongly affected bladder function, but in these cases, compensation by the non-disturbed PSN improved urinary bladder function 3 months after the operation. It seems possible that the lower-grade branches to the urinary bladder in the PSN may control bladder function. Uroflowmetry, amount of residual urine, cystometry, and urinary bladder compliance were all useful in assessing disturbance of branches to the urinary bladder in the PSN. To assess the grade of severe Clinical cases, it proved the most convenient to examine the uroflowmetry and amount of residual urine.

Adult↗

PubMed1952

[Neurosurgical analgesia in incurable genital cancer; results with Thiermann's sacral resection of the hypogastric and pelvic nerves].

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Analgesia↗

PubMed1952

Reflex excitation of cells in the inferior mesenteric ganglion on stimulation of the hypogastric nerve.

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Autonomic Nervous System↗

PubMed1987

The critical hypogastric circulation.

Eleven patients had ischemic complications secondary to ligation, hypoperfusion, exclusion, or thrombosis of the hypogastric arteries after aortoiliac reconstruction or spontaneous aortoiliac thrombosis. Ligation of one hypogastric artery resulted in persistent ipsilateral buttock claudication in three patients. Bilateral acute hypogastric artery ischemia occurred in eight patients and resulted in paralysis in all eight patients, buttock necrosis in four patients, anal and bladder sphincteric dysfunction in two patients, and colorectal ischemia in three patients. Five of these patients (63 percent) died. The mortality rate was 100 percent when buttock necrosis developed. In most of these patients, the neurologic deficit suggested ischemic injury of the lumbosacral plexus rather than spinal cord ischemia. These complications occurred despite patent bypass grafts to the iliac or femoral vessels. These observations suggest that it is essential to maintain patency of the hypogastric vessels in all aortoiliac reconstructions.

Aged↗

PubMed1990

Gluteal necrosis after acute ischemia of the internal iliac arteries.

Ligation of the internal iliac artery mostly remains without consequences because of the well established collateral network. In patients with compromised collateral circulation however, acute interruption of both hypogastric arteries during aorto-iliac surgery or transluminal embolisation can lead to necrosis of the gluteal muscles and other adjacent organs (rectum, bladder, lumbosacral plexus). Experience with 3 similar cases after aorto-iliac surgery demonstrates two main intraoperative mechanisms: 1. Embolisation, 2. Ligature of both internal iliac arteries in patients with compromised arteriosclerotic collaterals. Despite of adequate therapy, mortality is over 70%. The most important feature during aorto-iliac operations is to preserve at least one internal iliac artery by either reimplantation of the main stem or by an additional bypass to this artery.

Aged↗

PubMed1999

[Erection disorders after implantation of aorto-bifemoral prosthesis].

In this paper we present sexual complications occurring after implantation of vascular aorto-bifemoral prosthesis. We have sent an inquiry to 1236 men, who were operated in Vascular Department of Medical Academy in Wrocław in years 1983-1997. We received 659 answers. Additionally 302 patients were examined. We noticed disorders of erection after vascular operation in 350 cases. In 29 cases erection reappeared after operation. Only 112 patients declared correct ejaculation and 137 men have satisfied sexual life. This results present problem of postoperative ischaemia of minor pelvis and trauma to neural plexus of bifurcation of aorta. In cases of younger sexually active men, who need revascularisation of lower extremities by implantation of vascular aortobifemoral prosthesis we suggest endarterectomy of hypogastric artery and/or implantation this artery to prosthesis.

Adult↗

PubMed1983

Patterns of innervation of neurones in the inferior mesenteric ganglion of the cat.

The patterns of peripheral and central synaptic input to non-spontaneous, irregular discharging and regular discharging neurones in the inferior mesenteric ganglion of the cat were studied in vitro using intracellular recording techniques. All three types of neurones in rostral and caudal lobes received central synaptic input primarily from L3 and L4 spinal cord segments. Since irregular discharging neurones received synaptic input from intraganglionic regular discharging neurones, some of the central input to irregular discharging neurones may have been relayed through the regular discharging neurones. In the rostral lobes of the ganglion, more than 70% of the non-spontaneous and irregular discharging neurones tested received peripheral synaptic input from the lumbar colonic, intermesenteric and left and right hypogastric nerves. Most of the regular discharging neurones tested received synaptic input from the intermesenteric and lumbar colonic nerves; none of the regular discharging neurones received synaptic input from the hypogastric nerves. Some of the peripheral synaptic input from the lumbar colonic and intermesenteric nerves to irregular discharging neurones may have been relayed through the regular discharging neurones. Axons of non-spontaneous and irregular discharging neurones located in the rostral lobes travelled to the periphery exclusively in the lumbar colonic nerves. Antidromic responses were not observed in regular discharging neurones during stimulation of any of the major peripheral nerve trunks. This suggests these neurones were intraganglionic. In the caudal lobes, irregular discharging neurones received a similar pattern of peripheral synaptic input as did irregular discharging neurones located in the rostral lobes. The majority of irregular discharging neurones in the caudal lobes projected their axons to the periphery through the lumbar colonic nerves. Non-spontaneous neurones in the caudal lobes, in contrast to those located in the rostral lobes, received peripheral synaptic input primarily from the hypogastric nerves. Axons of the majority of non-spontaneous neurones located in the caudal lobes travelled to the periphery through hypogastric nerves. The results suggest that non-spontaneous neurones and irregular discharging neurones in the rostral lobes and the majority of irregular discharging neurones in the caudal lobes transact and integrate neural commands destined for abdominal viscera supplied by the lumbar colonic nerves. Non-spontaneous neurones in the caudal lobes transact and integrate neural commands destined for pelvic viscera supplied by the hypogastric nerves.

Action Potentials↗

PubMed1994

[The use of the Babcock forceps for hemostasis of the pre-prostatic veins in radical prostatectomy of total cystoprostatectomy].

Haemostasis of Santorini's venous plexus during radical prostatectomy or total cystoprostatectomy is a delicate phase of the procedure which facilitates the conditions of the surgery and the postoperative course. Based on a series of 150 prostatectomies, the authors describe their technique using Babcock forceps for "en bloc "ligation of the venous plexus. After opening the pelvic aponeurosis and section of the puboprostatic ligaments, a Babcock forceps is placed above the urethra and prostatic apex, including all of Santorini's plexus enclosed by its fibrous tissue, allowing exposure of the abascular plane of cleavage situated between the anterior surface of the urethra and this plexus. Klikenberg scissors are then introduced into the depression formed underneath the jaws of the Babcock forceps and are guided by the index finger into the symmetrical depression of the other side. The hypogastric connective tissue is perforated lateromedially and the scissors are gently opened to enlarge the passage. A right-angle dissector is then inserted and grips n.1 or 2 absorbable suture material which, after removing the Babcock forceps, is used to tie all of the anterior venous complex. This technical device allows a more reproducible and standardised approach to this operative step.

Cystectomy↗

PubMed1999

Regional differences in the sympathetic innervation of the guinea pig large intestine by neuropeptide Y- and tyrosine hydroxylase-immunoreactive nerves of divergent extrinsic origin.

Region-specific patterns of nerves with immunoreactivity to neuropeptide Y (NPY) have been described previously in the submucous plexus of guinea pig large intestine. Because these may have functional significance, the possibility of similar, characteristic variations of NPY-like immunoreactivity (NPY-ir) in the myenteric plexus was explored. Regional differences were found in the occurrence and pattern of distribution of NPY-ir in the myenteric plexus of the guinea pig large intestine. NPY-ir was present rarely within neuron somata in any region of the large intestine, and NPY-ir nerve fibers were present only within the distal large intestine, increasing progressively in density from the distal spiral to the rectum. Lesion of the colonic nerves, but not the hypogastric, intermesenteric, or lumbar splanchnic nerves, resulted in a loss of NPY-ir in the distal spiral and transverse colon but not in the descending colon or rectum. Ring myotomies in the descending colon resulted in a loss of NPY-ir proximal to the lesion. Dual-labeling immunohistochemical studies revealed that the NPY-ir nerve fibers rarely contained immunoreactivity for tyrosine hydroxylase (TH). Extrinsic nerve lesions resulted in an unequivocal reduction in NPY-ir in intraganglionic fibers of the submucosal plexuses of the transverse colon and a partial loss in the distal spiral and descending colon: the rectum was unaffected; in only a minority of guinea pigs, however, was any decrease in the NPY-ir innervation of submucosal blood vessels detected. The principal projections of NPY-ir nerves were from and through the inferior mesenteric ganglion; however, NPY-ir was not colocalized with TH-ir. It is proposed that nonnoradrenergic, NPY-containing neurons located in the inferior mesenteric ganglion project through the colonic nerves and that these proximally directed fibers innervate the transverse colon and the distal spiral. Nonnoradrenergic, NPY-ir neurons lying in the pelvic ganglia or sacral sympathetic chain may make an important contribution to the innervation of the myenteric plexus of the rectum and the descending colon.

Animals↗

PubMed1977

Discrimination between nicotinic receptors in vertebrate ganglia and skeletal muscle by alpha-bungarotoxin and cobra venoms.

1. We have used snake neurotoxins, alpha-bungarotoxin and venoms from Naja naja siamensis and Naja nivea, to distinguish the nicotinic receptors of ganglia from those of skeletal neuromuscular junctions. 2. These neurotoxins failed to block responses of isolated guinea-pig longitudinal muscle with adherent myenteric plexus to the nicotinic agonists, nicotine or dimethylphenylpiperazinium, to acetylcholine (ACh), or to electrical field stimulation. 3. The toxins failed to affect responses of the isolated guinea-pig stomach to pregnaglionic stimulation by way of the vagus nerves or of the vas deferens to preganglionic stimulation via the hypogastric nerves. 4. Snake neurotoxins did not block non-adrenergic inhibitory responses of the rabbit small intestine to nicotine or electrical field stimulation. 5. Neurotoxins were ineffective blockers against nicotinic agonists in new-born rabbit or embryonic chick intestine. 6. Attempts to increase the penetration of the toxins into tissues with dimethylsulphoxide, exposure to hypertonic solutions, or to ethylene-diaminetetracetic acid did not enable the toxins to act as nicotinic antagonists. 7. In contrast to diaphragmatic or oesophageal skeletal neuromuscular junctions no binding of rhodamine or tritium labelled toxins to structures in ganglia could be detected. 8. No potential permeability barriers were found by electron microscopy of the ganglia of the guinea-pig myenteric plexus. 9. The tracers, lanthanum ion and ruthenium red, readily penetrated into all regions of the myenteric plexus including synaptic gaps. 10. It is concluded that the failure of snake neurotoxins to act as nicotinic antagonists or to bind to ganglia is not due to their inability to reach ganglionic nicotinic receptors. Therefore, it is likely that ganglionic nicotinic receptors are different from those of the skeletal neuromuscular junction.

Action Potentials↗

PubMed2002

Bladder activation: afferent mechanisms.

The major function of the lower urinary tract is to store and periodically evacuate urine from the bladder. This requires coordination of the smooth muscles of the bladder and urethra, and of the striated muscles of the outflow region and pelvic floor by a complex neural control system. Lumbosacral afferent fibers (pelvic afferents), but also afferents in the hypogastric and pudendal nerves, are of major importance for the regulation of the mechanisms for continence and micturition. In the bladder, afferent nerves have been identified suburothelially as well as in the detrusor muscle. Suburothelially, they form a plexus that lies immediately beneath the epithelial lining. This plexus is particularly dense in the bladder neck and the trigone. The most important afferents for the micturition process are myelinated Adelta-fibers and unmyelinated C-fibers. Immunocytochemical and tracing studies have revealed that numerous peptides, including substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, enkephalins, and cholecystokinin are localized either alone, or in combination, in afferent pathways of the bladder and urethra. The receptors on these nerves include: vanilloid receptors, purinoceptors, tachykinin, and prostanoid receptors. Extracellular adenosine triphosphate (ATP) has been found to mediate excitation of small-diameter sensory neurons via P2X3 receptors, and it has been proposed that in the bladder, distention causes release of ATP from the urothelium. ATP, in turn, can activate P2X3 receptors on suburothelial afferent nerve terminals to evoke a neural discharge. However, it is most likely that a cascade of inhibitory and stimulatory transmitters/mediators, as well as ATP, are involved in the transduction mechanisms underlying the activation of afferent fibers during bladder filling.

Adenosine Triphosphate↗

PubMed1985

[Cytophotometric study of catecholamines and acetylcholinesterase in neurons of the intramural plexus of the urinary bladder of the cat in controls and animals exposed to experimental conditions].

The intramural plexus of the cat urinary bladder was studied with histochemical methods for catecholamines and acetylcholinesterase. Ganglia of the plexus showed differences in the number of neurons (5 to 150 cells). They were adrenergic, cholinergic or mixed. Section of pelvic nerves increased the amount of catecholamines in adrenergic neurons and fibres and decreased the acetylcholinesterase activity. Section of hypogastric nerves did not affect the catecholamine level and acetylcholinesterase activity.

Acetylcholinesterase↗

PubMedDate not supplied

Neurophysiological basis of sympathetic nerve-preserving surgery for lower rectal cancer--a canine model.

BACKGROUND/AIMS: The relative contribution and interrelated compensation of sympathetic signals among sympathetic components in pelvic plexus remain undefined. This study was designed to investigate the genitourinary function in response to autonomic nerve preservation and severance using a canine model. METHODOLOGY: Eighteen mongrel dogs were randomly divided into 3 groups which received severance of the hypogastric nerves on either the right side, left side, or on both sides. The hypogastric nerves and sacral sympathetic trunks were electrically stimulated and the contraction pressure of the internal urethral orifice was measured immediately, at 1- and 3-month intervals. The ejaculation function and the length of time required to reach sexual orgasm were evaluated by manual penis-stimulation. RESULTS: The difference between the left and right sides of the normal hypogastric nerve in contribution to sympathetic signals was insignificant. Compared with the hypogastric nerve, the bilateral sacral sympathetic trunks were functionally trivial in controlling the closure of the internal urethral orifice. The preserved side of the hypogastric nerve compensated for the loss of sympathetic signals of the severed side within 1 month and, thereafter, remained stationary. In contrast, the functional compensation of bilateral sacral sympathetic trunks for the severed bilateral hypogastric nerves was insignificant. When the hypogastric nerve was preserved in one or both sides, all dogs maintained normal antegrade ejaculation. If bilateral hypogastric nerves were severed, 50.0% (3/6) of the dogs lost both emission and ejaculation function; 33.3% (2/6) presented with retrograde ejaculation; and, 16.7% (1/6) presented with combined retrograde ejaculation and reduced antegrade ejaculation. The time required to reach sexual orgasm was not affected by the severance of the hypogastric nerve. CONCLUSIONS: The normal genitourinary function could be maintained only when at least one side of the hypogastric nerve was preserved.

Animals↗

PubMed1971

The cat coeliac and hypogastric ganglia following post-ganglionic nerve ligation. A study by electron autoradiography and formol fluorescence techniques for noradrenaline distribution.

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Animals↗

PubMed2004

Pediatric blunt trauma resulting in major arterial injuries.

Ten children, aged 4 to 14 years, sustaining blunt arterial trauma from motor vehicle collisions (6), bicycle accidents (2), and falls (2) were identified over a 10-year period. The arteries injured included the common iliac (3), abdominal aorta (2), carotid (2), brachial (2), and the subclavian, renal, and femoral artery (1 each). One patient had three arterial injuries. Six patients had associated injuries including a pelvic and lumbar spine fracture, Horner's syndrome, liver laceration, skull fracture, open humerus fracture, small bowel serosal tear, and a brachial plexus injury. Definitive diagnosis was made using arteriography (6), computed tomography (CT) scan (2), and physical examination (2). The types of arterial injuries found included incomplete transection, complete transection with pseudo-aneurysm formation, traumatic arteriovenous (AV) fistulas, complete occlusion, and dissection. Repair was accomplished by hypogastric artery interposition or bypass grafting, synthetic grafting with polytetrafluoroethylene (PTFE), reverse saphenous vein grafting, or primary repair, depending on the circumstances. An AV fistula between the carotid artery and cavernous sinus was embolized. All grafts remained patent with exception of the aorto-renal bypass graft at follow-up ranging from 1 month to 3 years. The principles for repairing vascular injuries in children are slightly different than those in adults. Every effort should be made to use autogenous tissue such as the hypogastric artery or saphenous vein for repair if possible. If not, PTFE grafts can be used, although the long-term patency of these grafts in growing children is not known.

Accidental Falls↗

PubMed2000

Sympathetic pathways and adrenergic innervation of the penis.

The sympathetic nervous system is important for penile function: it mediates detumescence and may contribute to the maintenance of the penis in a non-erect state. The sympathetic preganglionic neurons are found in the intermediolateral gray matter of the spinal cord. Postganglionic neurons are located to the sympathetic chain ganglia, the inferior mesenteric, hypogastric and pelvic ganglia, and possibly to ganglia near the target organ. Sympathetic fibres can be found in the pelvic, cavernous, and pudendal nerves. Stimulation of the sympathetic pathways to the penis may, however, also produce erection. It has been suggested that the suprasacral vasodilator pathway is a sympathetic cholinergic pathway, operating through cholinergic neurons in the pelvic plexus. In the penis, there is a rich sympathetic, adrenergic innervation of the corpus cavernosum (CC) and the vasculature, and in particular of the helicine arteries. Sympathetic, adrenergic nerves also contain neuropeptide Y. Parasympathetic cholinergic nerves, which mediate CC relaxation and erection, contain not only acetylcholine, but also vasoactive intestinal polypeptide, nitric oxide synthase, and probably other mediators and/or mediator-synthesizing enzymes. Activation of sympathetic adrenergic nerves causes release of noradrenaline, acting on alpha-adrenoceptors in the trabecular smooth muscle of the CC and in penile vessels. The role of interactions between different transmitters and mediators, released from nerves or generated locally, in the regulation of contraction and relaxation of CC and penile vessels, needs further study.

Animals↗

PubMed2000

Sympathetic pathways and adrenergic innervation of the penis.

Journal Article↗