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Pelvic Plexus (Inferior Hypogastric Plexus)

plexus pelvicus (plexus hypogastricus inferior)

The pelvic plexus (inferior hypogastric plexus) is the paired rectangular neural plate on each side of the pelvis, approximately 4x5 cm, formed by the convergence of the hypogastric nerve (sympathetic, from the superior hypogastric plexus), the pelvic splanchnic nerves (parasympathetic, from S2-S4), and visceral afferent fibres. It lies lateral to the rectum and posterolateral to the bladder and prostate/uterus, sending branches to all pelvic viscera.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The pelvic plexus is the central autonomic switchboard of the pelvis and its injury during pelvic surgery produces bladder, bowel, and sexual dysfunction. In rectal cancer surgery (TME), the pelvic plexus lies lateral to the mesorectum and must be preserved by staying within the mesorectal fascial plane. Injury rates for bladder dysfunction after TME are 5-25%. In radical hysterectomy, the pelvic plexus is at risk as the cardinal and uterosacral ligaments are divided. Nerve-sparing TME and nerve-sparing radical hysterectomy aim to preserve the pelvic plexus lateral branches while achieving oncological clearance.

Pathology

Common Injuries & Conditions

Pelvic Plexus Injury During Total Mesorectal Excision

TME dissection outside the mesorectal fascial plane divides the pelvic plexus at its lateral visceral branches, producing post-operative voiding dysfunction (urinary retention or incontinence) and sexual dysfunction; staying strictly within the embryological mesorectal fascial plane during sharp dissection preserves the pelvic plexus and reduces autonomic complication rates.