Urogenital dysfunction. Chirurgendagen 2007 Sympathetic nerves T10-L2 Superior hypogastric plexus...

Urogenital dysfunction

Urogenital dysfunction

Chirurgendagen 2007

Sympathetic nerves

T10-L2

Superior hypogastric plexus

(SHP)

Hypogastric nerves

Inferior hypogastric plexus

(IHP)

T10-L2

Superior hypogastric plexus

(SHP)

Hypogestric nerves

Inferior hypogastric plexus

(IHP)

Chirurgendagen 2007

Sympathetic nerves

Chirurgendagen 2007

Sympathetic nerves

T10-L2

Superior hypogastric plexus

(SHP)

Hypogastric nerves

Inferior hypogastric plexus

(IHP)

Chirurgendagen 2007

Sympathetic nerves

T10-L2

Superior hypogastric plexus

(SHP)

Hypogastric nerves

Inferior hypogastric plexus

(IHP)

Urogenital dysfunction

Chirurgendagen 2007

Parasympathietic nerves

S2-4

Splanchnic nerves

Inferior hypogastric plexus

(IHP)

Chirurgendagen 2007

Parasympathetic nerves

S2-4

Splanchnic nerves

Inferior hypogastric plexus

(IHP)

Chirurgendagen 2007

Parasympathetic nerves

S2-4

Splanchnic nerves

Inferior hypogastric plexus

(IHP)

Difficulty in bladder emptying after TME

Lange MM Br J Surg in press

Risk factors for difficulty in bladder emptying

Lange MM Br J Surg in press

RR P

Damage splanchnic nerves 3.28 0.008

Preoperative dysfunction 3.15 <0.001

Blood loss ≥ 1500 ml 1.95 0.038

Etiology of difficulty in bladder emptying after TME

Urinary incontinence after TME

Lange MM Br J Surg in press

Risk factors for urinary incontinence

RR p

Preoperative incontinence 3.42 <0.001

Female gender 2.37 0.002

Age ≥65 years 1.96 0.014

Anastomotic level <6 cm 1.72 0.049

Lange MM Br J Surg in press

Etiology urinary incontinence after TME

• Diminished support to urethra and bladder neck (menopause)• Pelvic floor dysfunction