MP10-08 AN ANATOMICAL PERSPECTIVE OF POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTIONS: THE AORTIC PLEXUS AND VARIATIONS IN LUMBAR VESSELS (2014)

You have accessJournal of UrologyPenis/Testis: Benign & Malignant Disease II1 Apr 2014MP10-08 AN ANATOMICAL PERSPECTIVE OF POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTIONS: THE AORTIC PLEXUS AND VARIATIONS IN LUMBAR VESSELS Tyler Beveridge, Marjorie Johnson, Adam Power, Brian Allman, and Nicholas Power Tyler BeveridgeTyler Beveridge More articles by this author , Marjorie JohnsonMarjorie Johnson More articles by this author , Adam PowerAdam Power More articles by this author , Brian AllmanBrian Allman More articles by this author , and Nicholas PowerNicholas Power More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-chemotherapy retroperitoneal lymph node dissection (pc-RPLND) for testis cancer is a highly technical procedure where an advanced knowledge of retroperitoneal anatomy is essential. The presence of aberrant lumbar vessels may lead to intraoperative complications and damage to the aortic plexus often results in retrograde ejaculation. Despite attempts to minimize complications using unilateral template dissections, there has never been a robust anatomical description completed of the neurovascular structure of the retroperitoneum. The aim of this study is to determine the variation and patterns in the lumbar vessels and to map the nerves of the aortic plexus so these structures can be properly navigated during surgery. METHODS Patterns and variations in the lumbar vessels were determined through embalmed cadaveric dissections (n=25) and the aortic plexus was mapped in fresh, frozen human cadavers (n=7). Using standard histochemical procedures, ganglia of the aortic plexus were verified with H&E staining while anti-tyrosine hydroxylase staining confirmed the presence of sympathetic neurons. RESULTS Vascular dissections revealed a left-side dominance of lumbar veins that were not equally-spaced; rather, the inter-vein distance progressively increased for the more inferior veins. In contrast, the lumbar arteries were bilaterally symmetrical, and showed a consistent inter-artery distance in the superior-inferior axis along the abdominal aorta. All aortic plexus dissections (7 of 7) revealed four distinct ganglia supplied by right and left, L1 and L2 lumbar splanchnic nerves; three previously identified ganglia (right/left spermatic ganglia and inferior mesenteric ganglion), and one newly discovered ganglion. CONCLUSIONS Our anatomical description of the lumbar vessels and the nerves of the aortic plexus may prove useful for surgeons performing pc-RPLND. We observed distinct patterns of variation in the lumbar vasculature that has never been described, as well as correlations between the positions of lumbar vessels with respect to surgical landmarks (inferior mesenteric artery, gonadal vein and left renal vein). In addition, we identified peripheral nerve pathways within the aortic plexus which we hypothesize contain fibres controlling ejaculation. Finally, the newly discovered ganglion may be integral in preserving fertility in males undergoing pc-RPLND. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e117 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Tyler Beveridge More articles by this author Marjorie Johnson More articles by this author Adam Power More articles by this author Brian Allman More articles by this author Nicholas Power More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...