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Day EP, Johnston BR, Bazarek SF, Brown JM, Lemos N, Gibson EI, Hurban HN, Fecho SB, Holt-Bright L, Eun DD, Pontari MA, De EJ, McGovern FJ, Ruggieri MR, Barbe MF. Anatomical Location of the Vesical Branches of the Inferior Hypogastric Plexus in Human Cadavers. Diagnostics (Basel) 2024; 14:794. [PMID: 38667441 PMCID: PMC11049538 DOI: 10.3390/diagnostics14080794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
We have demonstrated in canines that somatic nerve transfer to vesical branches of the inferior hypogastric plexus (IHP) can be used for bladder reinnervation after spinal root injury. Yet, the complex anatomy of the IHP hinders the clinical application of this repair strategy. Here, using human cadavers, we clarify the spatial relationships of the vesical branches of the IHP and nearby pelvic ganglia, with the ureteral orifice of the bladder. Forty-four pelvic regions were examined in 30 human cadavers. Gross post-mortem and intra-operative approaches (open anterior abdominal, manual laparoscopic, and robot-assisted) were used. Nerve branch distances and diameters were measured after thorough visual inspection and gentle dissection, so as to not distort tissue. The IHP had between 1 to 4 vesical branches (2.33 ± 0.72, mean ± SD) with average diameters of 0.51 ± 0.06 mm. Vesical branches from the IHP arose from a grossly visible pelvic ganglion in 93% of cases (confirmed histologically). The pelvic ganglion was typically located 7.11 ± 6.11 mm posterolateral to the ureteral orifice in 69% of specimens. With this in-depth characterization, vesical branches from the IHP can be safely located both posterolateral to the ureteral orifice and emanating from a more proximal ganglionic enlargement during surgical procedures.
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Affiliation(s)
- Emily P. Day
- MD Program, Drexel University College of Medicine, Philadelphia, PA 19129, USA;
- Center for Translational Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA; (E.I.G.); or (M.R.R.)
| | - Benjamin R. Johnston
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (B.R.J.); (S.F.B.)
| | - Stanley F. Bazarek
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (B.R.J.); (S.F.B.)
| | - Justin M. Brown
- Neurosurgery Paralysis Center, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02115, USA;
| | - Nucelio Lemos
- Department of Obstetrics and Gynecology, University of Toronto Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada;
| | - Eve I. Gibson
- Center for Translational Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA; (E.I.G.); or (M.R.R.)
| | - Helaina N. Hurban
- MD Program, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Susan B. Fecho
- School of Visual, Performing and Communication Arts, Barton College, Wilson, NC 27893, USA;
| | - Lewis Holt-Bright
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Daniel D. Eun
- Robotic Surgical Services, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
- Department of Urology, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Michel A. Pontari
- Department of Urology, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Elise J. De
- Department of Urology, Albany Medical Center, Albany, NY 12208, USA;
| | - Francis J. McGovern
- Department of Urology, Massachusetts General Hospital, Boston, MA 02115, USA;
| | - Michael R. Ruggieri
- Center for Translational Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA; (E.I.G.); or (M.R.R.)
- Neurosurgery Paralysis Center, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02115, USA;
| | - Mary F. Barbe
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA
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Verlinden TJM, Lamers WH, Herrler A, Köhler SE. The differences in the anatomy of the thoracolumbar and sacral autonomic outflow are quantitative. Clin Auton Res 2024; 34:79-97. [PMID: 38403748 PMCID: PMC10944453 DOI: 10.1007/s10286-024-01023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/12/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE We have re-evaluated the anatomical arguments that underlie the division of the spinal visceral outflow into sympathetic and parasympathetic divisions. METHODOLOGY Using a systematic literature search, we mapped the location of catecholaminergic neurons throughout the mammalian peripheral nervous system. Subsequently, a narrative method was employed to characterize segment-dependent differences in the location of preganglionic cell bodies and the composition of white and gray rami communicantes. RESULTS AND CONCLUSION One hundred seventy studies were included in the systematic review, providing information on 389 anatomical structures. Catecholaminergic nerve fibers are present in most spinal and all cranial nerves and ganglia, including those that are known for their parasympathetic function. Along the entire spinal autonomic outflow pathways, proximal and distal catecholaminergic cell bodies are common in the head, thoracic, and abdominal and pelvic region, which invalidates the "short-versus-long preganglionic neuron" argument. Contrary to the classically confined outflow levels T1-L2 and S2-S4, preganglionic neurons have been found in the resulting lumbar gap. Preganglionic cell bodies that are located in the intermediolateral zone of the thoracolumbar spinal cord gradually nest more ventrally within the ventral motor nuclei at the lumbar and sacral levels, and their fibers bypass the white ramus communicans and sympathetic trunk to emerge directly from the spinal roots. Bypassing the sympathetic trunk, therefore, is not exclusive for the sacral outflow. We conclude that the autonomic outflow displays a conserved architecture along the entire spinal axis, and that the perceived differences in the anatomy of the autonomic thoracolumbar and sacral outflow are quantitative.
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Affiliation(s)
- Thomas J M Verlinden
- Department of Anatomy & Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
| | - Wouter H Lamers
- Department of Anatomy & Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andreas Herrler
- Department of Anatomy & Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - S Eleonore Köhler
- Department of Anatomy & Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
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Bertrand MM, Korajkic N, Osborne PB, Keast JR. Functional segregation within the pelvic nerve of male rats: a meso- and microscopic analysis. J Anat 2020; 237:757-773. [PMID: 32598494 PMCID: PMC7495281 DOI: 10.1111/joa.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 01/16/2023] Open
Abstract
The pelvic splanchnic nerves are essential for pelvic organ function and have been proposed as targets for neuromodulation. We have focused on the rodent homologue of these nerves, the pelvic nerves. Our goal was to define within the pelvic nerve the projections of organ-specific sensory axons labelled by microinjection of neural tracer (cholera toxin, subunit B) into the bladder, urethra or rectum. We also examined the location of peptidergic sensory axons within the pelvic nerves to determine whether they aggregated separately from sacral preganglionic and paravertebral sympathetic postganglionic axons travelling in the same nerve. To address these aims, microscopy was performed on the major pelvic ganglion (MPG) with attached pelvic nerves, microdissected from young adult male Sprague-Dawley rats (6-8 weeks old) and processed as whole mounts for fluorescence immunohistochemistry. The pelvic nerves were typically composed of five discrete fascicles. Each fascicle contained peptidergic sensory, cholinergic preganglionic and noradrenergic postganglionic axons. Sensory axons innervating the lower urinary tract (LUT) consistently projected in specific fascicles within the pelvic nerves, whereas sensory axons innervating the rectum projected in a complementary group of fascicles. These discrete aggregations of organ-specific sensory projections could be followed along the full length of the pelvic nerves. From the junction of the pelvic nerve with the MPG, sensory axons immunoreactive for calcitonin gene-related peptide (CGRP) showed several distinct patterns of projection: some projected directly to the cavernous nerve, others projected directly across the surface of the MPG to the accessory nerves and a third class entered the MPG, encircling specific cholinergic neurons projecting to the LUT. A subpopulation of preganglionic inputs to noradrenergic MPG neurons also showed CGRP immunoreactivity. Together, these studies reveal new molecular and structural features of the pelvic nerves and suggest functional targets of sensory nerves in the MPG. These anatomical data will facilitate the design of experimental bioengineering strategies to specifically modulate each axon class.
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Affiliation(s)
- Martin M Bertrand
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Vic., Australia.,Department of Visceral Surgery, CHU de Nîmes, Nîmes, France.,Montpellier Laboratory of Informatics, Robotics and Microelectronics (LIRMM), ICAR Team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
| | - Nadja Korajkic
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Vic., Australia
| | - Peregrine B Osborne
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Vic., Australia
| | - Janet R Keast
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Vic., Australia
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Wang H, Li X, Wang Y, Sun J, Wang Y, Xu X, Zhang B, Shi J. Assessing Spinal Cord Injury Area in Patients with Tethered Cord Syndrome by Diffusion Tensor Imaging. World Neurosurg 2019; 127:e542-e547. [DOI: 10.1016/j.wneu.2019.03.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Vaginal and urethral histology is important to understanding the pathophysiology of the pelvic floor. METHODS En bloc removal of 4 female cadaveric pelvises was performed, with 18 to 25 serial sections obtained from each. The vaginal and urethral lengths were divided into distal and proximal sections; urethra was divided into anterior and posterior segments as well. Innervation and vasculature were qualified as small and large and quantified per high-power field. RESULTS The mean vaginal length was 7.45 cm, and the mean urethral length was 3.38 cm. A distinct vaginal fibromuscular layer was noted, without evidence of a dense sheet of continuous collagen. An epithelial, lamina propria, and muscular layer surrounded the urethral lumen. Adipose and loose fibroconnective tissue separated the urethra from the anterior vagina in 41% of slides. Nerves and vasculature were concentrated in the lamina propria. More small nerves and vessels were grossly seen compared with larger counterparts in both the vagina and urethra. No significant differences in layer thickness, innervation, or vasculature were observed along the vaginal length. The posterior urethra had greater innervation than did the anterior (P = 0.012). The distal posterior urethra had more large vessels than did the proximal posterior urethra (P = 0.03). No other differences were noted in urethral sections. CONCLUSIONS A vaginal fibromuscular layer was confirmed, refuting a true fascia. Innervation and vasculature were quantitatively the same along the anterior vagina. However, the posterior urethra had greater innervation than did anterior and is most innervated proximally. Nerve and vascular histology may relate to pelvic floor disorder etiology.
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