Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus...

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Urogenital dysfunction

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Transcript of Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus...

Page 1: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Urogenital dysfunction

Page 2: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Urogenital dysfunction

Page 3: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Chirurgendagen 2007

Sympathetic nerves

T10-L2

Superior hypogastric plexus

(SHP)

Hypogastric nerves

Inferior hypogastric plexus

(IHP)

Page 4: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

T10-L2

Superior hypogastric plexus

(SHP)

Hypogestric nerves

Inferior hypogastric plexus

(IHP)

Chirurgendagen 2007

Sympathetic nerves

Page 5: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Chirurgendagen 2007

Sympathetic nerves

T10-L2

Superior hypogastric plexus

(SHP)

Hypogastric nerves

Inferior hypogastric plexus

(IHP)

Page 6: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Chirurgendagen 2007

Sympathetic nerves

T10-L2

Superior hypogastric plexus

(SHP)

Hypogastric nerves

Inferior hypogastric plexus

(IHP)

Page 7: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Urogenital dysfunction

Page 8: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Chirurgendagen 2007

Parasympathietic nerves

S2-4

Splanchnic nerves

Inferior hypogastric plexus

(IHP)

Page 9: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Chirurgendagen 2007

Parasympathetic nerves

S2-4

Splanchnic nerves

Inferior hypogastric plexus

(IHP)

Page 10: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Chirurgendagen 2007

Parasympathetic nerves

S2-4

Splanchnic nerves

Inferior hypogastric plexus

(IHP)

Page 11: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Difficulty in bladder emptying after TME

Lange MM Br J Surg in press

Page 12: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Risk factors for difficulty in bladder emptying

Lange MM Br J Surg in press

RR P

Damage splanchnic nerves 3.28 0.008

Preoperative dysfunction 3.15 <0.001

Blood loss ≥ 1500 ml 1.95 0.038

Page 13: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Etiology of difficulty in bladder emptying after TME

Page 14: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Urinary incontinence after TME

Lange MM Br J Surg in press

Page 15: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Risk factors for urinary incontinence

RR p

Preoperative incontinence 3.42 <0.001

Female gender 2.37 0.002

Age ≥65 years 1.96 0.014

Anastomotic level <6 cm 1.72 0.049

Lange MM Br J Surg in press

Page 16: Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus (SHP) Hypogastric nerves Inferior hypogastric plexus.

Etiology urinary incontinence after TME

• Diminished support to urethra and bladder neck (menopause)• Pelvic floor dysfunction


Spinal nerves, cervical, lumbar and sacral plexus

Spinal nerves, cervical, lumbar and sacral plexus

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Concomitant variations of the brachial plexus and third part of … · 2017. 6. 20. · peripheral nerves of the upper limb [1]. The brachial plexus is divided into supraclavicular

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