Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd G6.238, Dallas, TX, 75390, USA.
Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.
Int Urogynecol J. 2023 Dec;34(12):3023-3032. doi: 10.1007/s00192-023-05645-8. Epub 2023 Oct 5.
Retropubic procedures may disrupt nerves supplying the pelvic viscera; however, knowledge of pelvic neuroanatomy is limited. We sought to characterize somatic and autonomic nerve density within the urethra, periurethral tissue, and anterior vagina.
Axial sections were obtained from pelvic tissue harvested from female cadavers ≤24 h from death at three anatomical levels: the midurethra, proximal urethra, and upper trigone. Periurethral/perivesical tissue was divided into medial and lateral sections, and the anterior vagina into middle, medial, and lateral sections. Double immunofluorescent staining for beta III tubulin (βIIIT), a global axonal marker, and myelin basic protein (MBP), a myelinated nerve marker, was performed. Threshold-based automatic image segmentation distinguished stained areas. Autonomic and somatic density were calculated as percentage of tissue stained with βIIIT alone, and with βIIIT and MBP respectively. Statistical comparisons were made using nonparametric Friedman tests.
Six cadavers, aged 22-73, were examined. Overall, autonomic nerve density was highest at the midurethral level in the lateral and middle anterior vagina. Somatic density was highest in the external urethral sphincter (midurethra mean 0.15%, SD ±0.11; proximal urethra 0.19%, SD ±0.19). Comparison of annotated sections revealed significant differences in autonomic density among the lateral, medial, and middle vagina at the midurethra level (0.71%, SD ±0.48 vs 0.60%, SD ±0.48 vs 0.70%, SD ±0.63, p=0.03). Autonomic density was greater than somatic density in all sections.
Autonomic and somatic nerves are diffusely distributed throughout the periurethral tissue and anterior vagina, with few significant differences in nerve density among sections analyzed. Minimizing tissue disruption near urethral skeletal muscle critical for urinary continence may prevent adverse postoperative urinary symptoms.
耻骨后入路手术可能会损伤供应盆腔内脏的神经；然而，盆腔神经解剖学知识有限。我们试图描述尿道、尿道周围组织和前阴道内的躯体和自主神经密度。
从死亡后≤24 小时的女性尸体中获取盆腔组织的轴向切片，在三个解剖学水平：中尿道、近尿道和上三角。将尿道周围/膀胱周围组织分为内侧和外侧部分，前阴道分为中间、内侧和外侧部分。进行β III 微管蛋白（β IIIT），一种通用轴突标志物，和髓鞘碱性蛋白（MBP），一种有髓神经标志物的双重免疫荧光染色。基于阈值的自动图像分割区分染色区域。自主和躯体密度分别计算为仅用β IIIT 染色的组织百分比和用β IIIT 和 MBP 染色的组织百分比。使用非参数 Friedman 检验进行统计比较。
共检查了 6 具尸体，年龄 22-73 岁。总体而言，自主神经密度在中尿道水平的尿道旁和中间前阴道的外侧和中部最高。躯体密度在外尿道括约肌最高（中尿道平均 0.15%，SD ±0.11；近尿道 0.19%，SD ±0.19）。对注释部分的比较显示，中尿道水平的阴道外侧、内侧和中间的自主神经密度存在显著差异（0.71%，SD ±0.48 与 0.60%，SD ±0.48 与 0.70%，SD ±0.63，p=0.03）。在所有切片中，自主神经密度均大于躯体神经密度。
自主和躯体神经广泛分布于尿道周围组织和前阴道，分析的切片之间神经密度差异较小。尽量减少对尿道骨骼肌的组织损伤至关重要，因为这是控制尿失禁的关键，可能预防术后不良的排尿症状。
