266. Careful dissection of the distal ureter in radical pelvic surgery is highly important: A reappraisal for the vesical plexus

Background: After the introduction of the total mesorectal excision (TME) the pelvic autonomic network has been widely studied. Optimal pelvic function is warranted by combined action of the sympathetic and parasympathetic nervous systems. Surgical preservation of both systems is highly important during radical pelvic surgery. The ‘Holy Plane’ is a well-known concept as is the surgical preservation of the inferior hypogastric plexus (IHP). However, preservation of the nerves branching from the IHP essentially innervating the pelvic viscera has gained less attention. Classical anatomy books have reported on a vesical plexus to be situated anterolaterally to the distal ureter innervating the bladder. Recent studies do not uniformly mention this plexus and might depict the distal ureter as a nerveless safe surgical zone. The aim of this study is to examine the presence of this vesical plexus and describe the implications for radical nerve-sparing pelvic surgery.