Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
J Sex Med. 2012 Jun;9(6):1566-78. doi: 10.1111/j.1743-6109.2012.02711.x. Epub 2012 Apr 10.
Vaginal sling procedures may have a negative effect on sexual function due to damage to vascular and/or neural genital structures. Even though autonomic innervation of the clitoris plays an important role in female sexual function, most studies on the neuroanatomy of the clitoris focus on the sensory function of the dorsal nerve of the clitoris (DNC). The autonomic and somatic pathways in relationship to sling surgery have up to the present not been described in detail.
The aim of this study is to reinvestigate and describe the neuroanatomy of the clitoris, both somatic and autonomic, in relation to vaginal sling procedures for stress urinary incontinence.
Serially sectioned and histochemically stained pelves from 11 female fetuses (10-27 weeks of gestation) were studied, and three-dimensional reconstructions of the neuroanatomy of the clitoris were prepared. Fourteen adult female hemipelves were dissected, after a tension-free vaginal tape (TVT) (7) or tension-free vaginal tape-obturator (TVT-O) (7) procedure had been performed.
Three-dimensional (3-D) reconstruction and measured distance between the clitoral nerve systems and TVT/TVT-O.
The DNC originates from the pudendal nerve in the Alcock's canal and ascends to the clitoral bodies. In the dissected adult pelves, the distance of the TVT-O to the DNC had a mean of 9 mm. The cavernous nerves originate from the vaginal nervous plexus and travel the 5 and 7 o'clock positions along the urethra. There, the autonomic nerves were found to be pierced by the TVT needle. At the hilum of the clitoral bodies, the branches of the cavernous nerves medially pass/cross the DNC and travel further alongside it. Just before hooking over the glans of the clitoris, they merge with DNC.
The DNC is located inferior of the pubic ramus and was not disturbed during the placement of the TVT-O. However, the autonomic innervation of the vaginal wall was disrupted by the TVT procedure, which could lead to altered lubrication-swelling response.
阴道吊带手术可能会因对血管和/或生殖器神经结构的损伤而对性功能产生负面影响。尽管阴蒂的自主神经支配在女性性功能中起着重要作用，但大多数关于阴蒂神经解剖学的研究都集中在阴蒂背神经（DNC）的感觉功能上。吊带手术相关的自主和躯体神经通路直到现在还没有详细描述。
本研究旨在重新研究和描述与阴道吊带治疗压力性尿失禁相关的阴蒂的躯体和自主神经解剖结构。
研究了 11 例女性胎儿（10-27 周妊娠）的连续切片和组织化学染色骨盆，并制备了阴蒂神经解剖的三维重建。对 14 例成年女性半骨盆进行了解剖，这些女性在进行无张力阴道吊带（TVT）（7 例）或无张力阴道吊带-闭孔器（TVT-O）（7 例）手术后。
三维（3-D）重建和测量阴蒂神经系统与 TVT/TVT-O 之间的距离。
DNC 起源于阴部管中的阴部神经，向上延伸至阴蒂体。在解剖的成年骨盆中，TVT-O 与 DNC 的距离平均值为 9 毫米。海绵体神经起源于阴道神经丛，沿尿道 5 点和 7 点位置行进。在那里，自主神经被 TVT 针刺穿。在阴蒂体的隆突处，海绵体神经的分支向内侧穿过/交叉 DNC，并沿着它进一步行进。就在阴蒂头上钩住之前，它们与 DNC 合并。
DNC 位于耻骨支下方，在 TVT-O 放置过程中未受干扰。然而，阴道壁的自主神经支配被 TVT 手术中断，这可能导致润滑肿胀反应改变。
