A clinicoanatomical study of the novel nerve fibers linked to mechanisms of female pelvic organ prolapse

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Descent and dysfunction of a pelvic floor organ have caused degradation of quality of life of a senior citizen with progress of aging society, and consequently, it interferes with successful aging. As for the muscle of support mechanism of pelvic floor organs, analysis of anatomy of the fascia, the connective tissue and the innervation will be fundamental and important data to develop the high quality therapy that took urination, evacuation and reproductive function into consideration. The aim of the study was to anatomically identify nerve fibers located around vaginal wall associated with the pathogenesis of pelvic organ prolapse. The novel nerve fibers immunohistochemically identified in the anterior vaginal wall are different from those of the common nervous system or the pelvic floor and are associated with the pathogenesis of urethral hypermobility. The nerve fiber immunohistochemically identified in this study was present inward than nerve bundle of pelvic splanchnic nerves repo … More rted previously and originated from the cranial part of the pelvic plexus, and appeared to terminate at the urethral smooth muscles. These novel nerve fibers will play an important role for an urethra support function. In the present year, we demonstrated that they occurred in the postjunctional sympathetic nerve immunohistochemically stained with S-100 and tyrosin hydroxylase antibody more from the head side of pelvic plexus in this year and identified that it was the nerve fascicle which continued in urethra plain muscle. Furthermore, we analyzed the posterior vaginal wall structure. The fascial configuration of posterior vagina which is connected pubocervical fascia, uterosacral ligament and paracervical ring wall was present between vagina and rectum as a rich plate of elastic fiber, but it was often thin and often interrupted. The central tendon of perineum (perineal body) connected to rectovaginal fascia offered anchoring apparatus with fibromuscular elasticity of 3-15mm long to superior vagina to 10-30mm long in the outside lower part. Pudendal nerve divergence is granted along inferior margin and breakdown by episiotomy might be concerned about. Finally I observed that a pelvic splanchnic nerve and levator ani muscle nerve ran locus of ischial spine inside 18.0mm over sacrospinous ligament, 12-26mm bottom at ischial spine bottom and enters a muscle in front of outside 40-55mm in coccyx. Less