Characterizing the Topography of the Vesical Portion of the Inferior Hypogastric Plexus and its Associated Endopelvic Fascial Planes: Informing Nerve‐sparing Ureteric Reimplantation Surgery
Bibliographic record
Abstract
Extravesical ureteric reimplantation is an effective treatment for vesicoureteral reflux. Concerningly, when performed bilaterally, it is associated with a 10‐15% incidence of postoperative urinary retention and is postulated to be caused by iatrogenic damage to the nearby pelvic autonomic nerves. Unfortunately, an effective nerve‐sparing surgical approach is limited by a lack of comprehensive anatomical knowledge of these nerves (i.e., location, distribution, density). Thus, this study aims to investigate the anatomy of the autonomic nerves within the endopelvic fascial planes and in the vicinity of the ureterovesical junction (UVJ), in fresh and ethanol‐phenol‐fixed human cadavers. To address this, the present study utilized gross dissection to identify the course of the autonomic nerves within the endopelvic fascial planes to contextualize their anatomical position and aid in surgical identification (Objective 1). Subsequently, we sought to examine the position and density of pelvic autonomic nerve fibers in the soft tissue surrounding the UVJ using western blot and semi‐quantitative densitometry analysis (Objective 2). Findings from nine specimens (n= 9 cadavers; 8 males, 1 female) revealed a common endopelvic fascial plane including the gonadal vessels, ureters, and hypogastric nerves (from lateral to medial, respectively), that overlays the abdominal aorta. The region posterior to this plane was found to be continuous with the pre‐sacral space inferiorly. The fascial plane containing the vas deferens in male specimens was differentiable from this common plane and can be seen intersecting proximal to the UVJ. The characterization of pelvic autonomic nerve fiber density, specifically surrounding the UVJ using western blot analysis, is ongoing. This study provides the first identification of hypogastric nerves (medial), ureters (between) and gonadal vessels (lateral) situated in a common endopelvic fascial plane (n= 9), an inferior continuation of the renal fascia, specifically the internal layers of Gerota's & Zuckerkandle's. Knowledge of these endopelvic fascial planes, paired with ongoing densitometry analysis in Objective 2, will provide the necessary anatomical foundation for future research to further refine nerve‐sparing surgical approaches of ureteric reimplantation. Acknowledgements: Kaitlin Marshall, Dale Fournier, Mariyan Jeyarajah, Stephen Renaud, Haley Linklater, Kevin Walker and the UWO anatomy lab donors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".