Post on 05-Jan-2016
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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