ABSTRACT A thorough understanding of pelvic autonomic anatomy is essential for contemporary neuroprotective surgical techniques, which strive to balance oncological radicality with the preservation of normal tissue function. Originally developed for prostatectomy and subsequently adapted for rectal resections and hysterectomy, these approaches underscore the critical importance of precise anatomical knowledge. Most research on true pelvis autonomic nerve plexuses published after 1990 emphasizes topography from a clinical perspective, aiming to map plexus organization to minimize iatrogenic injury and safeguard pelvic organ function. In contrast, investigations examining the composition, fiber characteristics, and trajectories of autonomic nerves remain comparatively rare. This study investigated the hypogastric nerves and inferior hypogastric plexus in 50 adult cadavers (18 female, 32 male) using dissection under an operating microscope combined with immunohistochemical analysis. The macroscopic structure and variability of the plexuses were documented, and the composition of the nerve fibers was assessed. In all specimens, the inferior hypogastric plexus appeared as two independently coursing “plates,” interconnected by numerous macroscopically visualized adrenergic nerve interconnections located superficially in the retroperitoneal and preperitoneal regions, and deep in the area of the pelvic diaphragm and deep perineal muscles. The hypogastric nerves consisted of several to a dozen nerve bundles, primarily DBH‐positive sympathetic fibers with a smaller proportion of VAChT‐positive cholinergic fibers. Along their course and within branches of the inferior hypogastric plexus, numerous VAChT‐positive and, to a lesser extent, DBH‐positive clusters of nerve cells forming prevertebral ganglia were encountered. These ganglia were often of mixed cholinergic–adrenergic nature, with a predominance of the cholinergic component.
Kоt et al. (Tue,) studied this question.