2022 AMI Online Salon

Pelvic Visceral Nerve Anatomy

Project Details

  • Entrant Name:  Hannah Ely
  • Client: Khurshid A. Guru, MD
  • Copyright: Roswell Park Comprehensive Cancer Center, ATLAS, 2022
  • Medium/software used: Adobe Photoshop, Adobe Illustrator, ZBrush
  • Final presentation format: Surgical atlas / clinical textbook
  • Primary Audience: Expert and training urologic surgeons

Project Description

Nerve-sparing (NS) cystectomy is a treatment for bladder cancer. In this surgery, the bladder and other organs are removed and the autonomic nerves of the pelvic visceral plexus that supply erectile tissue and the external urethral sphincter are spared to preserve sexual function and continence. Historically, this procedure has been recommended for male patients. Now, more surgeons are attempting to bring NS techniques to female patients. The purpose of these illustrations is to provide detailed anatomy of the plexuses showing pathways of autonomic innervation from the SHP to the cavernous nerves and structures being innervated. The layout compares male and female anatomy, showing analogous structures and critical differences surgeons must understand as they perform NS more widely. Inclusion of the pudendal nerve and its branches shows overlapping somatic innervation. Because these nerves cannot be seen in the surgical field, surgeons must be confident in this anatomy.  These illustrations—informed by several recent papers, cadaveric dissections, 3D modeled CT data, and review by expert surgeons—will be published in a urologic atlas to educate surgeons on techniques, procedures, and surgical anatomy. Although male pelvic plexus anatomy is better studied and understood, the exact course of these nerves in male and female patients is yet to be confirmed. Giving surgeons this visual comparison is crucial for successful outcomes for all patients as NS technique is expanded.