ABSTRACT
Adenomyosis is associated with dysmenorrhea and chronic pelvic pain; however, the triggering mechanisms of painful stimuli and the role of uterine nerve fibers in the manifestation of pain remain poorly understood. The objective of this study was to systematically review the role of uterine nerve fibers' presence and density in the occurrence of pain in patients with adenomyosis. An electronic search was performed using the Embase, PubMed/Medline, and Cochrane databases. We included all studies from inception to November 2023. A total of ten studies that compared uterine biopsies samples of women with and without adenomyosis were included. The biomarker antiprotein gene product 9.5 was decreased or absent in the endometrium of most included women with adenomyosis. None of the included studies observed a difference in neurofilament (NF) staining between the adenomyosis and non-adenomyosis groups. Studies that assessed nerve growth factor (NGF) staining were heterogeneous in design. One study reported no difference in immunohistochemistry staining in any endometrial layer between the adenomyosis and non-adenomyosis groups, while another reported increased staining in the adenomyosis functional endometrial layer, and a third study reported overexpression of NGF, synaptophysin (SYN), and microtubule-associated protein 2 mRNA in focal adenomyosis alone. Preliminary data from poor-quality studies suggest an increase in the uterine density of nerve fibers in patients with adenomyosis. Well-designed studies are essential to assess the cause-and-effect relationship between uterine nerve fibers and pain in patients with adenomyosis.
Subject(s)
Adenomyosis , Uterus , Humans , Female , Adenomyosis/metabolism , Adenomyosis/pathology , Adenomyosis/complications , Uterus/innervation , Uterus/pathology , Uterus/metabolism , Pelvic Pain/metabolism , Pelvic Pain/etiology , Pelvic Pain/pathology , Peripheral Nerves/pathology , Peripheral Nerves/metabolism , Endometrium/innervation , Endometrium/metabolism , Endometrium/pathology , Dysmenorrhea/metabolismABSTRACT
No abstract available.
Subject(s)
Female , Humans , Hysterectomy/methods , Organ Sparing Treatments , Pelvis/innervation , Rectum/innervation , Urinary Bladder/innervation , Uterine Cervical Neoplasms/surgery , Uterus/innervationABSTRACT
OBJECTIVE: Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. METHODS: After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. RESULTS: Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. CONCLUSION: NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
Subject(s)
Female , Humans , Constipation/epidemiology , Hysterectomy/adverse effects , Intraoperative Complications/epidemiology , Organ Sparing Treatments/adverse effects , Pelvis/innervation , Rectum/innervation , Sexual Dysfunction, Physiological/epidemiology , Urinary Bladder/innervation , Urinary Retention/epidemiology , Uterine Cervical Neoplasms/epidemiology , Uterus/innervation , Vagina/innervationABSTRACT
OBJECTIVE: A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. METHODS: From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. RESULTS: There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
Subject(s)
Adult , Female , Humans , Middle Aged , Adenocarcinoma/mortality , Carcinoma, Adenosquamous/mortality , Carcinoma, Squamous Cell/mortality , Hysterectomy/adverse effects , Organ Sparing Treatments/adverse effects , Pelvis/innervation , Recovery of Function , Survival Analysis , Treatment Outcome , Urinary Bladder/innervation , Uterine Cervical Neoplasms/mortality , Uterus/innervationABSTRACT
Procedeu-se a uma revisäo bibliográfica sobre a distribuiçäo, origem e possíveis papéis fisiológicos do neurotransmissor polipeptídeo vasoactivo intestinal (VIP), no útero. O VIP está presente no útero de mamíferos em geral, localizando-se em fibras nervosas, cujo número é maior na cervice uterina em comparaçäo com o restante do órgäo. As fibras nervosas vipérgicas orientam-se ao longo de células musculares lisas e ao redor de glândulas e vasos sanguíneos, e originam-se dos gânglios nervosos paracervicais, situados na junçäo cérvice uterina-vagina. Os efeitos do VIP no útero, encontrados até o momento, säo os seguintes: 1) relaxamento da musculatura lisa uterina; 2) vasodilataçäo; 3) possível participaçäo em processos secretores.
Subject(s)
Uterus/innervation , Vasoactive Intestinal Peptide/physiology , Nerve FibersABSTRACT
Apresenta-se uma revisäo sobre a inervaçäo autônoma do útero de mamíferos.
Subject(s)
Animals , Female , Mammals , Uterus/innervation , Acetylcholine/physiology , Nerve Fibers/physiology , Norepinephrine/physiology , Ovary/innervation , Nerve Endings/physiologyABSTRACT
Antecedentes: En la cirugía del cáncer de recto, próstata y útero es necesario conocer la inervación autónoma urogenital a fin de realizar una resección radical con preservación de dicha inervación. Objetivo: Determinar los jalones apropiados para la investigación del plexo presacro, nervios y plexo hipogástrico inferior, erectores en su origen y trayecto que siguen hacia los órganos genitourinarios. Lugar de aplicación: Hospital Público. Diseño: Trabajo de investigación anatómico. Población: 7 especímenes, 5 masculinos y 2 femeninos, se disecaron en total 10 plexos. Método: a) investigación del plexo presacro, nervios y plexo hipogástrico inferior y erectores; b) resección en bloque con un segmento de órganos vecinos; c) estaqueada la pieza es sumergida en formol y Complucad; d) disección de los plexos, fotografías y esquemas; e) biopsias de segmentos de dichos plexos. Resultados: Los erectores dependientes del 3§ y 4§ nervio espinal estuvieron presentes en todas las piezas. Los originados en S3 eran de mayor envergadura y alcanzaban el plexo hipogástrico inferior, los originados en S4 eran finos y discurrían directamente hacia el pene, 1 caso se integraba al plexo hipogástrico inferior; en 2 especímenes hubo anastomosis entre ambos plexos hipogástricos. Conclusiones: en todos los especímenes estaban presentes los nervios erectores. Los de mayor envergadura eran los del 3§ espinal. Los del 4§ espinal discurrían directamente hacia el pene. Las raíces espinales 2§, 3§ y 4§ y el músculo piramidal son jalones importantes en la localización de los erectores
Subject(s)
Humans , Male , Female , Autonomic Pathways , Colorectal Surgery/adverse effects , Dissection , Medical Errors/prevention & control , Lumbosacral Plexus , Hypogastric Plexus/injuries , Research , Adnexa Uteri , Lumbosacral Plexus , Ovary , Prostate/innervation , Rectal Neoplasms , Rectum , Spinal Nerve Roots , Spinal Nerves , Urinary Bladder , Uterus/innervation , Vagina , Vas Deferens , Seminal Vesicles/innervationABSTRACT
Antecedentes: En la cirugía del cáncer de recto, próstata y útero es necesario conocer la inervación autónoma urogenital a fin de realizar una resección radical con preservación de dicha inervación. Objetivo: Determinar los jalones apropiados para la investigación del plexo presacro, nervios y plexo hipogástrico inferior, erectores en su origen y trayecto que siguen hacia los órganos genitourinarios. Lugar de aplicación: Hospital Público. Diseño: Trabajo de investigación anatómico. Población: 7 especímenes, 5 masculinos y 2 femeninos, se disecaron en total 10 plexos. Método: a) investigación del plexo presacro, nervios y plexo hipogástrico inferior y erectores; b) resección en bloque con un segmento de órganos vecinos; c) estaqueada la pieza es sumergida en formol y Complucad; d) disección de los plexos, fotografías y esquemas; e) biopsias de segmentos de dichos plexos. Resultados: Los erectores dependientes del 3º y 4º nervio espinal estuvieron presentes en todas las piezas. Los originados en S3 eran de mayor envergadura y alcanzaban el plexo hipogástrico inferior, los originados en S4 eran finos y discurrían directamente hacia el pene, 1 caso se integraba al plex
Subject(s)
Humans , Male , Female , Hypogastric Plexus/injuries , Lumbosacral Plexus/anatomy & histology , Research , Autonomic Pathways , Medical Errors/prevention & control , Colorectal Surgery/adverse effects , Dissection , Lumbosacral Plexus/injuries , Rectum/innervation , Urinary Bladder/innervation , Prostate/innervation , Seminal Vesicles/innervation , Vas Deferens/innervation , Uterus/innervation , Vagina/innervation , Adnexa Uteri/innervation , Ovary/innervation , Spinal Nerve Roots , Spinal Nerves , Rectal Neoplasms/surgeryABSTRACT
Oitenta e nove ratas albinas, virgens, adultas, pesando entre 100-200g eram injetadas, via intramuscular, com 0,5mg de benzoato de estradiol 72 horas antes de serem sacrificadas para o estudo da motilidade uterina isolada. Os segmentos de corno uterino ficavam suspensos em um banho de músculo liso e imersos em solução de Tyrode modificada a 34§C, borbulhada com ar atmosférico. A toxina do escorpião Tityus serrulatus, os agonistas, antagonistas e bloquadoes de canais de sódio eram adicionadas diretamente ao reservatório contendo o útero. O registro isométrico da atividade da musculatura uterina era feito com um transdutor FT03 conectado a um polígrafo da marca Grass, modelo 7D...