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The urogenital-hypogastric sheath: an anatomical observation on the relationship between the inferomedial extension of renal fascia and the hypogastric nerves

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Abstract

Purpose

The study aimed to perform an anatomical observation on the inferomedial extension of the renal fascia (RF) to the pelvis and explore its relationship with the hypogastric nerves (HGNs).

Methods

Gross anatomy was performed on 12 formalin-fixed and 12 fresh cadavers. Sectional anatomy was performed on four formalin-fixed cadavers.

Results

Different from the traditional concept, both the anterior and posterior RF included the outer and inner layer with different inferomedial extensions. The multiple layers of RF extended downward to form a sandwich-like and compound fascia sheath with potential and expandable spaces which was named as “the urogenital-hypogastric sheath.” Below the level of the origin of the inferior mesenteric artery, the bilateral urogenital-hypogastric sheath communicated with the counterpart in front of the great vessels in the midline and the superior hypogastric plexus ran into the urogenital-hypogastric sheath which carried the HGNs, ureters, and genital vessels downward to their terminations in the pelvis. In the retrorectal space, the urogenital-hypogastric sheath surrounded the fascia propria of the rectum posterolaterally as a layer of coat containing HGNs.

Conclusion

The multiple layers of RF with different extensions are the anatomical basis of the formation of the urogenital-hypogastric sheath. As a special fascial structure in the retroperitoneal space and the pelvis, emphasis on its formation and morphology may be helpful for not only unifying the controversies about the relationship between the pelvic fascia and HGNs but also improving the intraoperative preservation of the HGNs by dissecting in the correct surgical plane.

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Acknowledgments

This study was supported by the National Natural Science Foundation of China (31171153), the Guangdong province fund (2011B031800036), and the foundation of Guizhou health department ((2012)184).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Guizhou Provincial People’s Hospital, Guiyang, China

    X. F. Yang

  2. Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, China

    G. H. Luo

  3. Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, No.1838, Guangzhou Da Dao Bei, Guangzhou, 510515, China

    Z. H. Ding, G. X. Li & S. Z. Zhong

  4. Department of General Surgery, The First People’s Hospital of Shunde, Foshan, China

    X. W. Chen

Authors
  1. X. F. Yang
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  2. G. H. Luo
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  3. Z. H. Ding
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  4. G. X. Li
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  5. X. W. Chen
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  6. S. Z. Zhong
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Corresponding author

Correspondence to Z. H. Ding.

Additional information

Yang XF and Luo GH contributed equally to this work.

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Yang, X.F., Luo, G.H., Ding, Z.H. et al. The urogenital-hypogastric sheath: an anatomical observation on the relationship between the inferomedial extension of renal fascia and the hypogastric nerves. Int J Colorectal Dis 29, 1417–1426 (2014). https://doi.org/10.1007/s00384-014-1973-0

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  • DOI: https://doi.org/10.1007/s00384-014-1973-0

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