title: The pelvic plexus and antireflux surgery: topographical findings and clinical consequences.
abstract: OBJECTIVE
  Voiding dysfunction and urinary retention are rare complications of antireflux surgery. As mainly reported after bilateral antireflux surgery with extravesical technique, bladder insufficiency has been suspected to be caused by intraoperative damage to neural structures. We studied the topography of the pelvic plexus and assessed the injury to the plexus resulting from antireflux surgery.
  
  
  METHODS
  Human cadavers fixed with Thiel solution were used for dissection. The superior hypogastric plexus and hypogastric nerves were identified as the pathway to the pelvic plexus. After dissecting the surrounding fatty tissue the S2 to S4 nerves and efferent nerve bundles from the pelvic plexus were identified.
  
  
  RESULTS
  The main portion of the pelvic plexus was located about 1.5 cm. dorsal and medial to the ureterovesical junction. The bundles of the pelvic plexus ended at the distal ureter, trigone and rectum. When simulating an antireflux procedure, there was a high risk of injury to the pelvic plexus and its efferent nerves if dissection was performed distal to the ureter and dorsal trigone.
  
  
  CONCLUSIONS
  Careful dissection close to the ureter avoids inadvertent injury to the pelvic plexus. To minimize the risk of voiding dysfunction bilateral antireflux surgery should be performed at 2 sessions unless the operative technique allows preservation of the neural structures.
authors.affiliation: Department of Urology, Otto-von-Guericke-University, Magdeburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Leissner
authors.forename: E P
authors.initials: EP
authors.lastname: Allhoff
authors.forename: W
authors.initials: W
authors.lastname: Wolff
authors.forename: C
authors.initials: C
authors.lastname: Feja
authors.forename: M
authors.initials: M
authors.lastname: Höckel
authors.forename: P
authors.initials: P
authors.lastname: Black
authors.forename: R
authors.initials: R
authors.lastname: Hohenfellner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology* / Q000293:injuries; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014513:Ureter / Q000033:anatomy & histology; D001743:Urinary Bladder / Q000033:anatomy & histology; D014555:Urination Disorders / Q000209:etiology / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000601:surgery*