[Nerve-sparing cystectomy technique in the woman].
With the advent of the nerve-sparing and urethral-support-sparing cystectomy technique, the urethral closure mechanism and the rhabdosphincter muscle of the lower urethra are left intact. The fibers of the interior hypogastric plexus supporting the urethra and the vagina remain intact. The autonomic nerve fibers are particularly at risk at two points: where they cross under the ureters between the uterine and vaginal arteries and in the bladder neck area. In both areas damage must bei avoided by careful dissection. The endopelvic fascia is incised immediately lateral to the posterior urethra at the urethrovesical junction. As much as possible of the urethropelvic ligament and the paraurethral vascular and nerve plexus must be saved. The urethrovesical junction is dissected off the anterior vaginal wall down to the posterior bladder wall. The cardinal ligaments are divided well anterior to avoid the pelvic plexus. The superior vesical artery and uterine vessels are cross-clamped, cut and tied. Once the uterine artery is transsected, the distal ureter comes into view and can be isolated, avoiding damage to the nerve fibers. The vaginal cavity is entered by a transverse incision, and the edges of the vaginal incision are held open with Ellis clamps. The distal stump of the ureter following its division is pulled medially to facilitate dissection of the lateral bladder wall. The perivesical vascular plexus and the inferior hypogastric plexus, which is located laterally to the vessels, are separated from the lateral wall of the bladder and vagina. (ABSTRACT TRUNCATED AT 250 WORDS)
Hautmann
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RE
Urologische Universitätsklinik Ulm.
de Petriconi
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R
D001341:Autonomic Nervous System / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000473:pathology / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D014521:Urethra / Q000294:innervation* / Q000473:pathology; D001743:Urinary Bladder / Q000294:innervation* / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology; D014621:Vagina / Q000294:innervation / Q000473:pathology / Q000601:surgery