Bladder, bowel and sexual function after hysterectomy for benign conditions (original) (raw)
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Surgical and Radiologic Anatomy, 2007
Objective To locate and describe the various eVerences 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: identiWcation 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 Xoor 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 eVerences originate in the paracervix. Three eVerent 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 eVerences 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 Xoor encountered after certain hysterectomies and/or surgical treatments of vesicoureteral reXux.
Changes in the function of the lower urinary tract after hysterectomy
International Urogynecology Journal, 1993
The relationship between the performance of hysterectomy and the function of the lower urinary tract is assessed on the basis of epidemiological and urodynamic studies. Urinary symptoms develop, but also disappear, after hysterectomy. The postoperative prevalence of urinary symptoms is for the major part determined by the preoperative prevalence, which is statistically significantly higher compared to the prevalence of urinary symptoms in the normal population. Apparently, women scheduled for hysterectomy for benign gynecological disease, are somehow different from women not undergoing hysterectomy. However, urodynamic investigations do not show what the difference is. From urodynamic analysis it becomes apparent that hysterectomy causes temporary interruption of bladder function due to surgical injury of the bladder wall. Except for this finding, urodynamic studies show that postoperative lower urinary tract function is essentially determined by preoperative function. Bladder and urethral dysfunction is only likely to develop when the surgical procedure is extended into the paravaginal tissues or when the pelvic plexus is located in the field of normal surgical dissection.
AJP: Regulatory, Integrative and Comparative Physiology, 2006
Central nervous system neurons process information converging from the uterus, colon and bladder, partly via the hypogastric nerve. This processing is influenced by the estrous cycle, suggesting the existence of an estrous-modifiable central nervous system substrate by which input from one pelvic organ can influence functioning of other pelvic organs. Here we tested predictions from this hypothesis that acute inflammation of colon, uterine horn, or bladder would produce signs of inflammation in the other uninflamed organs (increase vascular permeability), and that cross-organ effects would vary with estrous and be eliminated by hypogastric neurectomy (HYPX). Under urethane anesthesia, the colon, uterine horn, or bladder of rats in proestrus or metestrus, with or without prior HYPX, was treated with mustard oil or saline. Two hours later, Evans Blue dye extravasation was measured to assess vascular permeability.
Effects of vaginal hysterectomy on anorectal sensorimotor functions - a prospective study
Neurogastroenterology & Motility, 2012
Background-While bowel and bladder dysfunction are recognized consequences of a radical hysterectomy, the effects of a simple hysterectomy on anorectal sensorimotor functions, particularly rectal sensation, vary among studies and the effects on rectal compliance are unknown. Our aims were to prospectively evaluate anorectal sensorimotor functions before and after a hysterectomy.
1997 Role of pelvic floor in bladder function II vagina
The aim of the study was to examine the role of vaginal stretching during bladder neck opening and closure. The study group comprised 12 patients with GSI and 4 controls. The position of the bladder neck relative to the vagina was assessed in the resting, straining and 'squeezing' positions using video-radiological studies. Radio-opaque dye was instilled into the bladder, vagina, rectum and levator plate. Vascular clips applied to the midurethral, bladder neck and bladder base parts of the anterior vaginal wall assisted in determining differential movements of these parts of the vagina during bladder neck opening and closure. The suburethral vagina (hammock) was shown to stretch downwards and forwards during straining, and downwards and backwards during micturition. The bladder neck, upper part of the vagina and the rectum were stretched backwards and downwards in an identical manner during straining and micturition, apparently in response to backward contraction of the levator plate and downward angulation of its anterior lip. All organs were stretched upwards and forwards during 'squeezing'. The findings support the hypothesis that, during stress and micturition, selective pelvic floor contractions stretch the vagina against intact pubourethral and uterosacral ligaments to assist opening and closure of the urethra and bladder neck.
Impaired contraction and decreased detrusor innervation in a female rat model of pelvic neuropraxia
International urogynecology journal, 2016
Bilateral pelvic nerve injury (BPNI) is a model of post-radical hysterectomy neuropraxia, a common sequela. This study assessed the time course of changes to detrusor autonomic innervation, smooth muscle (SM) content and cholinergic-mediated contraction post-BPNI. Female Sprague-Dawley rats underwent BPNI or sham surgery and were evaluated 3, 7, 14, and 30 days post-BPNI (n = 8/group). Electrical field-stimulated (EFS) and carbachol-induced contractions were measured. Gene expression was assessed by qPCR for muscarinic receptor types 2 (M2) and 3 (M3), collagen type 1α1 and 3α1, and SM actin. Western blots measured M2 and M3 protein expression. Bladder sections were stained with Masson's trichrome for SM content and immunofluorescence staining for nerve terminals expressing vesicular acetylcholine transporter (VAChT), tyrosine hydroxylase (TH), and neuronal nitric oxide synthase (nNOS). Bilateral pelvic nerve injury caused larger bladders with less SM content and increased colla...