title: New insights in the neuroanatomy of the human adult superior hypogastric plexus and hypogastric nerves.
abstract: BACKGROUND
  The superior hypogastric plexus (SHP) is an autonomic plexus, located ventrally to the abdominal aorta and its bifurcation, innervating pelvic viscera. It is classically described as being composed of merely sympathetic fibres. However, post-operative complications after surgery damaging the peri-aortic retroperitoneal compartment suggest the existence of parasympathetic fibres. This immunohistochemical study describes the neuroanatomical composition of the human mature SHP.
  
  
  METHODS
  Eight pre-determined retroperitoneal localizations including the lumbar splanchnic nerves, the SHP and the HN were studied in four human cadavers. Control tissues (white rami, grey rami, vagus nerve, splanchnic nerves, sympathetic ganglia, sympathetic chain and spinal nerve) were collected to verify the results. All tissues were stained with haematoxylin and eosin and antibodies S100, tyrosine hydroxylase (TH), vasoactive intestinal peptide (VIP) and myelin basic protein (MBP) to identify pre- and postganglionic parasympathetic and sympathetic nerve fibres.
  
  
  RESULTS
  All tissues comprising the SHP and hypogastric nerves (HN) showed isolated expression of TH, VIP and MBP, revealing the presence of three types of fibres: postganglionic adrenergic sympathetic fibres marked by TH, unmyelinated VIP-positive fibres and myelinated preganglionic fibres marked by MBP. Analysis of control tissues confirmed that TH, VIP and MBP were well usable to interpret the neurochemical composition of the SHP and HN.
  
  
  CONCLUSIONS
  The human SHP and HN contain sympathetic and most likely postganglionic parasympathetic fibres. The origin of these fibres is still to be elucidated, however surgical damage in the peri-aortic retroperitoneal compartment may cause pelvic organ dysfunction related to both parasympathetic and sympathetic denervation.
authors.affiliation: Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kraima
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Schaik
authors.affiliation: Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Serhat
authors.initials: S
authors.lastname: Susan
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Cornelius J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaap F
authors.initials: JF
authors.lastname: Hamming
authors.affiliation: Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Egbert A J F
authors.initials: EA
authors.lastname: Lakke
authors.affiliation: Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: M.C.DeRuiter@lumc.nl.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: DeRuiter
mesh_terms: D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology* / Q000378:metabolism; D007150:Immunohistochemistry; D008159:Lumbar Vertebrae; D004676:Myelin Basic Protein / Q000378:metabolism; D010275:Parasympathetic Nervous System / Q000033:anatomy & histology* / Q000378:metabolism; D009418:S100 Proteins / Q000378:metabolism; D013153:Splanchnic Nerves / Q000033:anatomy & histology / Q000378:metabolism; D013564:Sympathetic Nervous System / Q000033:anatomy & histology* / Q000378:metabolism; D014446:Tyrosine 3-Monooxygenase / Q000378:metabolism; D014660:Vasoactive Intestinal Peptide / Q000378:metabolism
chemical_list: D004676:Myelin Basic Protein; D009418:S100 Proteins; D014660:Vasoactive Intestinal Peptide; D014446:Tyrosine 3-Monooxygenase
keywords: Autonomic nervous system; Hypogastric nerves; Parasympathetic nervous system; Superior hypogastric plexus; Vasoactive intestinal peptide