caa a22 4500 463199464 CHVBK 20180405153108.0 cr unu---uuuuu 170326e20070401xx s 000 0 eng 10.1007/s00276-007-0195-3 doi (NATIONALLICENCE)springer-10.1007/s00276-007-0195-3 Systematization of the vesical and uterovaginal efferences of the female inferior hypogastric plexus (pelvic): applications to pelvic surgery on women patients [Elektronische Daten] [B. Mauroy, B. Bizet, J. Bonnal, T. Crombet, T. Duburcq, C. Hurt] Objective: To locate and describe the various efferences of the plexus in order to make it easier to avoid nerve lesions during pelvic surgery on women patients through a better anatomical knowledge of the inferior hypogastric plexus (IHP). Materials and methods: We dissected 27 formalin embalmed female anatomical subjects, none of which bore any stigmata of subumbilical surgery. The dissection was always performed using the same technique: identification of the inferior hypogastric plexus, whose posterior superior angle follows on from the hypogastric nerve and whose top, which is anterior and inferior, is located exactly at the ureter's point of entry into the base of the parametrium, underneath the posterior layer of the broad ligament. Results: The IHP is located at the level of the posterior floor of the pelvis, opposite to the sacral concavity. Its top, which is anterior inferior, is at the point of contact with the ureter at its entry into the posterior layer of the broad ligament. The uterovaginal, vesical and rectal efferences originate in the paracervix. Three efferent nerves branch, two of them from its top and the third from its inferior edge: (1) A vaginal nerve, medial to the ureter, follows the uterine artery and divides into two groups: anterior thin, heading for the vagina and the uterus; posterior, voluminous, heading in a superior rectal direction (=superior rectal nerve). (2) A vesical nerve, lateral to the ureter, divides into two groups, lateral and medial. (3) The inferior rectal nerve emerges from the inferior edge of the IHP, between the fourth sacral root and the ureter's point of entry into the base of the parametrium. Conclusion: The ureter is the crucial point of reference for the IHP and its efferences and acts as a real guide for identifying the anterior inferior angle or top of the IHP, the origin of the vaginal nerve, the level of the ureterovesical junction and the division of the vesical nerve into its two medial and lateral branches. Dissecting underneath and inside the ureter and the uterine artery involves a risk of lesion of the vaginal nerve and its uterovaginal branches. Further forward, between the intersection and the ureterovesical junction, dissecting and/or coagulating under the ureter involves a risk of lesions to the vesical nerve, which are likely to explain the phenomena of denervation of the anterior floor encountered after certain hysterectomies and/or surgical treatments of vesicoureteral reflux. Springer-Verlag, 2007 Urinary incontinence nationallicence Vesical innervation nationallicence Pelvic autonomous innervation nationallicence Hysterectomy nationallicence Inferior hypogastric plexus nationallicence Vesicorenal reflux nationallicence Autonomous nervous system nationallicence Mauroy B. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut Bizet B. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut Bonnal J. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut Crombet T. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut Duburcq T. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut Hurt C. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut Surgical and Radiologic Anatomy Springer-Verlag 29/3(2007-04-01), 209-217 0930-1038 29:3<209 2007 29 276 https://doi.org/10.1007/s00276-007-0195-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00276-007-0195-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mauroy B. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut NATIONALLICENCE 700 1- Bizet B. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut NATIONALLICENCE 700 1- Bonnal J. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut NATIONALLICENCE 700 1- Crombet T. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut NATIONALLICENCE 700 1- Duburcq T. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut NATIONALLICENCE 700 1- Hurt C. Anatomy Laboratory, Faculty of Medicine Research Center, Institute of Anatomy, 1, Place de Verdun, 59045, Lille Cedex, France aut NATIONALLICENCE 773 0- Surgical and Radiologic Anatomy Springer-Verlag 29/3(2007-04-01), 209-217 0930-1038 29:3<209 2007 29 276 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer