73 - Distal Innervation of the Bladder for Clinical Application to Ureteral Reimplantation Surgery

Poster Board Number: 73
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Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Meghan Frampton - Anatomy and Cell Biology - Schulich School of Medicine and Dentistry; Leyla Spennato - Schulich School of Medicine and Dentistry; Benjamin Laxer - Schulich School of Medicine and Dentistry; Tyler Beveridge, PhD - Assistant Professor, Anatomy and Cell Biology, Schulich School of Medicine and Dentistry

Abstract Body : Extravesical ureteral reimplantation surgery is a successful surgical option for vesicoureteral reflux, but postoperative complications such as urine retention and bladder dysfunction are commonly reported. These complications are due to iatrogenic injury to the parasympathetic innervation of the bladder, the precise location of which remains inconsistently defined. To address this, our study investigates the extent and morphology of the neural plexus supplying the urinary bladder in relation to the ureterovesical junction (UVJ). This study, employing human cadavers, aims to: 1) provide comprehensive account of the morphology of the vesical plexus in relation to its vasculature, 2) ascertain the position and distance of the nerves as they enter the bladder in respect to UVJ, and 3) characterize a previously undescribed ganglion observed anterior to the ureter during the study. Through dissection of 45 UVJs from 17 male (84.2 ± 11.6 years old) and 6 female (77.8 ± 7.7 years old) cadaveric hemisected pelvises, it was revealed that 1-12 nerves supplied the bladder on each side originating from the vesical plexus that exhibited either a laminar morphology lying medial to the vesical veins (54.3%), or a plexiform morphology intricately woven with the vesical veins (46.7%). The mean distance of nerves from UVJ was determined to be 1.3 ± 0.8 cm. Notably, the position of these nerves was predominantly posterior to the UVJ, both in the posterolateral (64.4%) and posteromedial (64.4%) quadrants. Additionally, a previously undescribed ganglion was observed anterior to the ureter, 1.7 ± 0.8 cm proximal to the UVJ. Hematoxylin & eosin staining confirmed the presence of neuron cell bodies in 85% of gross observations; subsequent immunohistochemistry will further determine its autonomic nature, which will aid in developing a working hypothesis about its potential role in bladder function. Taken together, the present study provides a detailed characterization of the vesical plexus and constituent ganglion in the region surrounding the UVJ. Importantly, these findings will serve as a crucial foundation for the ongoing development of nerve-sparing techniques in ureterovesical surgery.