ABSTRACT
Objective
The objective of the present study is to evaluate the anatomy of the inferior hypogastric plexus, correlating it with urological pathologies, imaging exams and surgeries of the female pelvis, especially for treatment of endometriosis.
Material and Methods
We carried out a review about the anatomy of the inferior hypogastric plexus in the female pelvis. We analyzed papers published in the past 20 years in the databases of Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials, and opinions of specialists. We also studied two human fixed female corpses and microsurgical dissection material with a stereoscopic magnifying glass with 2.5x magnification.
Results
Classical anatomical studies provide few details of the morphology of the inferior hypogastric plexus (IHP) or the location and nature of the associated nerves. The fusion of pelvic splanchnic nerves, sacral splanchnic nerves, and superior hypogastric plexus together with visceral afferent fibers form the IHP. The surgeon’s precise knowledge of the anatomical relationship between the hypogastric nerve and the uterosacral ligament is essential to reduce the risk of complications and postoperative morbidity of patients surgically treated for deep infiltrative endometriosis involving the uterosacral ligament.
Conclusion
Accurate knowledge of the innervation of the female pelvis is of fundamental importance for prevention of possible injuries and voiding dysfunctions as well as the evacuation mechanism in the postoperative period. Imaging exams such as nuclear magnetic resonance are interesting tools for more accurate visualization of the distribution of the hypogastric plexus in the female pelvis.
Hypogastric Plexus; Anatomy; Endometriosis; Magnetic Resonance Imaging
Thumbnail
Thumbnail
Thumbnail
Thumbnail
A) Schematic drawing of the superior hypogastric plexus in a female pelvis. It is possible to observe the relationships and the division of the SHP; B) The figure shows dissection of a female pelvis, indicating the division and the relationships of the SHP. 1- Superior hypogastric plexus; Right hypogastric nerve; Left hypogastric nerve; 4- Right common iliac artery; 5- Left common iliac artery and 6- Promontory.
A) The figure shows the right hypogastric nerve in a female pelvis and the formation of the IHP, indicating the splanchnic nerves (2) joining to the hypogastric nerve (1); B) Schematic drawing of the inferior hypogastric plexus in a female pelvis, indicating the relationships and the formation of the IHP, 1- hypogastric nerve, 2 – Splanchnic pelvic nerve and 3 – Inferior hypogastric plexus; C) The figure shows a female pelvis in one of the corpses dissected in our sample. It is possible to observe the uterus (U), the relationship between the ureter (UR) and the iliac vessels (IIV – internal iliac vessels and EIV – external iliac vessels), R- Rectum and D) The figure shows the same female pelvis of figure 2C after the dissection of the IHP. It is possible to observe the uterus (U), the peritoneum and the relationship between the nerves (N) of the inferior hypogastric plexus with the peritoneum and the uterus.
