Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis
Article first published online: 14 FEB 2003
Copyright © 2003 Wiley-Liss, Inc.
Volume 16, Issue 2, pages 119–130, March 2003
How to Cite
Baader, B. and Herrmann, M. (2003), Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin. Anat., 16: 119–130. doi: 10.1002/ca.10105
- Issue published online: 14 FEB 2003
- Article first published online: 14 FEB 2003
- Manuscript Revised: 16 AUG 2002
- Manuscript Received: 9 OCT 2001
- pelvic plexus;
- rectal surgery;
Bladder, bowel, and sexual dysfunction caused by iatrogenic lesions of the inferior hypogastric plexus (IHP) are well known and commonly tolerated in pelvic surgery. Because the pelvic autonomic nerves are difficult to define and dissect in surgery, and their importance often ignored, we conducted a gross anatomic study of 90 adult and four fetal hemipelves. Using various non-surgical approaches, the anatomic relations and pathways of the IHP were dissected. The IHP extended from the sacrum to the genital organs at the level of the lower sacral vertebrae. It originated from three different sources: the hypogastric nerve, the sacral splanchnic nerves from the sacral sympathetic trunk (mostly the S2 ganglion), and the pelvic splanchnic nerves, which branched primarily from the third and fourth sacral ventral rami. These fibers converge to form a uniform nerve plate medial to the vascular layer and deep to the peritoneum. The posterior portion of the IHP supplied the rectum and the anterior portion of the urogenital organs; nerve fibers traveled directly from the IHP to the anterolateral wall of the rectum and to the inferolateral and posterolateral aspects of the urogenital organs. The autonomic supply from the IHP was supplemented by nerves accompanying the ureter and the arteries. An understanding of the location of the autonomic pelvic network, including important landmarks, should help prevent iatrogenic injury through the adoption of surgical techniques that reduce or prevent postoperative autonomic dysfunction. Clin. Anat. 16:119–130, 2003. © 2003 Wiley-Liss, Inc.