Table 2 Areas with risk of lesion in the main autonomic nerves, and their effects
Nerve injured | Area of risk | Urinary dysf. | Sexual dysf. | |
|---|---|---|---|---|
SHP (sympathetic) |
| Dissection and ligature of IMA | Stress urinary incontinence | Retrograde ejaculation |
Hypogastric nerves | Posterior dissection | Alteration in ejaculation (no alteration erection) | ||
Splanchnic nerves (parasympathetic) |
| Rare in TME In radical lymph node dissections | Neurogenic bladder | Men: alteration erection Women: Dyspareunia |
IHP (mixed) |
| Lateral dissection | Incontinence Difficulty voiding | Problems with ejaculation and erection |
- IHP one-sided | Difficulty voiding | Men: Ejaculation and erection problems Women: Problems with genital lubrication | ||
- IHP two-sided | Bladder denervation | Men: impotence Women: dyspareunia and ↓ability to reach orgasm | ||
Neurovascular bundle of Walsh and cavernous nerve | Anterior dissection | Men: impotencia and erectile dysfunction Women:dispareunia and reduced genital lubrication | ||
Pudendo nerve and levator ani | Perineal stage of Miles APR | Urinary incontinence | Sexual sensorial impotence |
