title: Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers.
abstract: The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.
authors.affiliation: Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hinata
authors.affiliation: Department of Urology, Hiroshima University School of Medicine, Hiroshima, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hieda
authors.affiliation: Division of Gynecology and Obstetrics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Gynecology and Obstetrics, Fukui University School of Medicine, Fukui, Japan.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Kurokawa
authors.affiliation: Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
authors.affiliation: Division of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Murakami
authors.affiliation: Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Mineko
authors.initials: M
authors.lastname: Fujimiya
keywords: Denonvilliers' fascia; Internal anal sphincter; Pelvic nerve plexus; Pubocervical fascia; Rectovaginal septum