Masters of Science / There is a need for defined models of human nutritional disorders partly because serious misconceptions about models are common amongst researchers. Historically a large variety of species has been used including primates, pigs, rats, lagomorphs. Advantages various small carnivores and and disadvantages are not well known and availability is a major factor. In 1753 John Hunter used pigs to study bone growth in one of the first scientifically controlled nutrition experiments (Kobler 1960). Rats were most likely the first animals to be bred specifically for scientific purposes and there is evidence that they were used in nutrition experiments during the late eighteenth century (Kobler 1960). Experience with carcinogenesis in animals has shown the great diversity of results which may possibly be obtained from different species (Lave et al. 1988). This is pertinent to nutritional research as there is an established link between diet and cancer. The selection of a suitable substitute to attempt to model possible human response to a variety of procedures is dependent upon criteria among which the following are possibly the more important. Availability; this is of great importance in Southern Africa where the cost of importation of exotic species. must be taken into account. Du Plessis (1981) referred to the fact that our indigenous primates were a valuable resource. A second consideration must be the cost the selected animal in a scientifically acceptable environment. Keeping animals of maintaining and ethically for research purposes in an uncontrolled environment could well lead to erroneous conclusions being made. Thirdly the cost of a research program in which animals are used may be increased if there is insufficient knowledge of the model selected. A paucity of knowledge available about an animal may affect the viability of an experiment. The need for precise information regarding the effects of extended term dietary supplementation of experimental animals has been noted by Fincham et. al. (1987) . Additionally the selected animal should preferably have similar dietary requirements to man, and have a life span which will enable extended term investigations.

Titus Andronicus is infamously Shakespeare’s first, and bloodiest, tragedy, but only a few scholars link this violence with the Renaissance culture of anatomy and dissection. Although scholars mention the anatomical language in Titus Andronicus, their analyses stop short of more fully developing the rich relationship between dissection and Shakespeare’s play. To remedy this oversight, this paper explores the debt that Titus Andronicus owes to contemporary anatomy and dissection culture by comparing Titus Andronicus (est. 1590) with Andreas Vesalius’s revolutionary anatomy textbook, De Humani Corporis Fabrica (1543). Specifically, this paper will identify four major intents of the Fabrica: 1) to display, 2) to instruct, 3) to interpret, and 4) to aestheticize the interior of the human body, and illustrate how these four traits figure in the representation of Lavinia’s body in the play. By mirroring the Fabrica’s four intents in both anatomy text and play, as well as examining the Fabrica’s images and text itself, this analysis reveals a pertinent difference. While in many ways Titus Andronicus celebrates the De Humani Corporis Fabrica, the play applies a heavy dose of skepticism to Vesalius’s underlying epistemological assumption that the body is knowable.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24831号 / 医博第4999号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本, 洋介, 教授 武藤, 学, 教授 永井, 純正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The present research examined remains found from the Winchester Site in Winchester, MA that have evidence for postmortem alteration. The author compared the assemblages from Point San Jose (Hart et al. 2019; Willey et al. 2018), Holden Chapel (Hodge 2013; Hodge et al. 2017), Medical College of Georgia (Blakley 1997; McFarlin and Wineski 1997; Terrell and McFarlin 1997), Milwaukee County Institutional Grounds (Dougherty and Sullivan 2017), Newcastle Infirmary (Chamberlain 2016), and Blockley Almshouse (Crist et al. 2017; Hynes 2005) regarding patterns in bone modification and their potential causes. The sawn assemblage consists of 1365 adult remains, 67 juvenile remains, and 13 nonhuman remains. The human adult sawn Winchester Site sample is composed of 19.7% cranial remains and 80.3% postcranial remains. The postmortem alterations found on the remains from the Winchester Site lack pathological changes surrounding them. Eight of the 17 (47.0%) nearly complete crania exhibit evidence for craniotomy. Postmortem trephinations are seen in three crania. Repetition of surgical procedure training is seen through the 349 transverse complete kerfs located on the postcranial remains. There are 125 sternal segments and 133 rib segments with evidence of sharp force trauma, potentially from thoracotomy. The postmortem alteration within the faunal assemblage can be attributed to butchery on the elements from cow, sheep, and unidentified mammal, and dissection on the elements from the dog and red fox. Implements utilized on the skeletal remains were a flat-bladed saw with 18 teeth per inch (TPI) and a trephine. The remains from the Winchester Site exhibit experimentation with kerf locations, most likely originating from surgical training practices.

This dissertation examines how advocates for anatomical medicine in the early American republic defended medical training through dissection by framing anatomy as a Protestant spiritual and civic initiative. The project draws attention to prominent anatomists and anatomy advocates from the 1760s to the 1830s who did not dismiss the religious values and rhetoric of the people who rioted against dissections and bodysnatching, but instead imaginatively remodeled the Christian principles that had been wielded against them. Utilizing the public forums that were afforded to them as wealthy white Protestant intellectuals, these figures drew upon the mythologies of the new nation as well as the New Testament to defend the practice of dissection and persuade a largely Protestant public of the virtues of the dissected corpse. As this project will emphasize, they also used evangelical Protestant ideology to justify the pillaging of African American cemeteries and almshouse burial grounds for dissection subjects. Reinforcing an evangelical Protestant and portrait of nativist American citizenship, their rhetoric would ultimately play a powerful role in shaping state intervention in the regulation of medical schools and their supply of anatomical subjects. This project ultimately aims to reframe our understanding of the discursive formation of the dead body as a medical subject in the early republican era, seeking to illuminate how dead bodies were talked about—how they were discursively formed—by those who opened and examined them: practitioners of practical anatomy who not only dissected dead bodies, and likely disinterred them, but also launched public campaigns to repurpose them as tools of medical training. Tapping into the era’s evangelical postmillennialist rhetoric of resurrection, these figures petitioned the state and the public to draw a line between the respectable white citizens who contributed to civic progress, whose bodies would remain undisturbed after burial, and indigent and non-white populations, who could be made productive after death. At once religious and medical, their rhetoric functioned epistemically to transform medical training into a mode of Protestant civic discipleship, and to transform the dead bodies of socially and politically burdensome populations into redeemed post-mortem vessels of medical advancement. Recognizing the production of medical knowledge in the United States in a wide range of genres, authored by writers operating within as well as outside of the fledgling orthodox medical establishment, this dissertation analyzes the imaginative writings, both positive and critical, of doctors, ministers, satirists, novelists, and legislators, all of whom registered and reflected upon the framing of practical anatomy as a conduit of Protestant civic initiative. In “Dr. Shippen’s Anatomical Theatre: Defending Dissection in Colonial Philadelphia,” I examine an early model of this rhetoric in the writings and orations of Dr. William Shippen, Jr., one of the earliest outspoken advocates of anatomical dissection in the colonies, demonstrating how Shippen relied on Protestant language and cultural norms—and the colonial newspaper—not only to align himself and his anatomy lectures with the city’s religious elite, but also to create a spiritual justification for the use of the bodies of poor, criminalized, and otherwise subjugated individuals as dissection subjects. The chapter closes by tracing how two subsequent texts, a satirical pamphlet poem by Francis Hopkinson and a landmark state legislative report in defense of anatomical dissection, registered and responded to this rhetoric, and to the collusion of Protestant virtue and medical authority as tools of social order. “The Enlightened Gospel of Anatomy on the Atlantic Stage” spotlights Presbyterian minister Samuel Stanhope Smith’s 1787 Essay on the Causes of the Variety of Complexion and Figure in the Human Species, and Federalist statesman Royall Tyler’s 1797 novel The Algerine Captive. Situating both texts within transnational debates about American degeneracy and the expansion of the American slave economy, I outline how each author mounts a defense of American health and character that is grounded in anatomical knowledge of the human body as well as a Protestant framework of moral virtue. Taken together, the texts bear witness to a growing confidence in doctors—particularly anatomists—to understand and order human difference, and they demonstrate the continuing rhetorical framing of anatomical medicine as a Protestant civic initiative in the decades after the American Revolution. The dissertation’s final chapter, “ ‘life, strength, and usefulness’: Resurrection and Redemption in Sheppard Lee,” examines the ongoing consolidation of Protestant rhetoric in support of anatomical medicine in the early nineteenth century, as both American and British lawmakers began to take up the case for legislation to regulate and protect anatomical training for medical students through dissection. The chapter begins by identifying the rhetoric of Philadelphia anatomist John Davidson Godman as a principal influence in the development of the first American anatomy legislation, demonstrating how Godman utilized the rhetoric of Protestant nativism to strategically position anatomical medicine as a beacon of enlightened Christianity in the young republic, while also preserving the secrecy of an illicit interstate corpse trafficking network centered in 1820s Philadelphia. The chapter then considers how a novel written by a physician who was trained in Philadelphia’s medical institutions during this period engages with Godman’s rhetoric, and with the various debates and philosophies surrounding anatomy legislation in the Anglo-Atlantic world. In Robert Montgomery Bird’s 1836 Sheppard Lee: Written by Himself, Bird mimes and critiques the rhetoric of utilitarian anatomy advocacy, as well as the Protestant rhetoric of redemptive dissection. Bird generates a provocative cultural portrait of institutionalized dissection in the Atlantic world, underscoring the political distinctions that ultimately determined which corpses should be protected, which should be dissected, and which should be preserved. Considering corpses not merely as abstractions or metaphors, but as literal, material entities that incited riots, spurred industries, and inspired nativist fantasies, this dissertation illuminates the fraught negotiations and acts of power that undergirded what is often regarded as a natural or inevitable narrative of modern secularization and scientific progress. At its most ambitious, this project aims to embody a new dimension of interdisciplinary work in the medical humanities, reshaping our understanding of the origins of the medical cadaver and prompting new reflection on the secular morality of postmortem medical research. / English

No description available.

Introduction : l’innervation et la vascularisation des corps caverneux du pénis sont très difficilement explorables par les techniques de dissection anatomiques classiques. De ce fait, elles demeurent pas très bien connues. La dissection anatomique assistée par ordinateur (CAAD), combinant méthodes immuno-histochimiques et reconstruction tridimensionnelle représente un outil original permettant l’analyse microscopique des artères et des nerfs au sein des corps caverneux. Les objectifs de ce travail étaient donc d’étudier l’innervation et la vascularisation microscopique des corps caverneux par dissection anatomique assistée par ordinateur (CAAD).Matériel et méthodes : Des coupes histologiques sériées de pénis ont été réalisées chez huit cadavres adultes masculins et sur des pièces issues de pénnectomie pour cancer à l’hôpital du kremlin-Bicêtre. Les coupes ont été traitées par des méthodes histologiques (Hématoxyline-Eosine et trichrome de Masson) et immuno-histochimiques pour détecter les fibres nerveuses (anti-S100), les fibres somatiques (anti-PMP22), les fibres adrénergiques (anti-TH), cholinergiques (anti-VAChT) et nitrergiques (anti-nNOS). Les lames ont ensuite été numérisées par un scanner de haute résolution optique et les images bidimensionnelles ont été reconstruites en trois dimensions grâce au logiciel WinSurf. Résultats: La reconstruction tridimensionnelle des coupes histologiques immuno-marquées a permis de décrire l’innervation et la vascularisation des corps caverneux du pénis. Les artères et les nerfs du pénis sont très largement anastomosés entre eux.Les anastomoses entre les artères caverneuses et les artères urétrales se font en dehors de l’albuginée du corps spongieux d’où le terme de « shunts caverno-urétraux » utilisé dans ce travail pour qualifier ces vaisseaux anastomotiques.La vascularisation et l’innervation permettent de distinguer deux compartiments anatomiques distincts au niveau du pénis : une partie proximale (les 2/3 du pénis) autonome dont les artères et les nerfs proviennent du plexus hypogastrique inférieur (supra-lévatorien), et le tiers distal somatique dont les artères et les nerfs proviennent des artères et nerfs dorsaux du pénis (infra-lévatorien).Les communications entre les systèmes autonomes et somatiques (entre le plexus hypogastrique inférieur supra-lévatorien et le nerf pudendal infra-lévatorien) existent donc à quatre niveaux : proximal, intermédiaire, à la racine du pénis et intracaverneuses. Les communications intracaverneuses sont responsables des marquages autonomes observés dans les nerfs dorsaux du pénis. Elles confèrent également aux corps caverneux une sensibilité à peu près semblable à celui du gland au cours de l’acte sexuel.Conclusion: Nos résultats montrent de très nombreuses anastomoses vasculaires et nerveuses dans les corps caverneux entre les systèmes supra et infra-lévatoriens avec 2 régions anatomiques distinctes : les 2/3 proximaux érectiles et le 1/3 distal sensitif. Ces anastomoses permettent d’espérer une certaine plasticité dans la vascularisation et l’innervation du pénis en cas de dysérection. / Introduction: The innervation and the vascularization of the corpora cavernosa of the penis are very difficult searchable by the classical anatomic dissections. Therefore, they remain not very well known. The computer-assisted anatomic dissection (CAAD), combining immunohistochemical methods and three-dimensional reconstruction is a unique tool for the microscopic analysis of the arteries and nerves in the corpora cavernosa.The objectives of this study were therefore to investigate the microscopic innervation and vascularization of the corpora cavernosa by the CAAD.Materials and methods: Serial histological sections of penis were performed in eight adult male cadavers and one piece after penectomy for cancer in the hospital of Kremlin Bicetre. The sections were processed by histological methods (hematoxylin-eosin and Masson trichrome) and immunohistochemistry to detect nerve fibers (anti-S100), somatic fibers (anti-PMP22), adrenergic fibers (anti-TH), cholinergic fibers (anti-VAChT) and nitrergic fibers (anti-nNOS). The slides were then scanned by a high resolution scanner and two-dimensional images were reconstructed in three dimensions using WinSurf software.Results: Three-dimensional reconstruction of immunolabeled histological sections allowed describing the innervation and vascularization of the corpora cavernosa of the penis. The arteries and nerves of the penis are widely anastomosed.The anastomoses between the cavernous arteries and urethral arteries are outside the tunica albuginea of the corpus spongiosum hence the term "cavernous urethral shunts".The innervation of the penis distinguishs two distinct anatomical portions: a proximal portion (2/3 of the penis) is autonomic whose arteries and nerves come from the inferior hypogastric plexus (supralevator), and the third including somatic distal nerves from the dorsal nerves of the penis (infralevator).The communications between autonomic and somatic systems (between the inferior hypogastric plexus and the pudendal nerve) exist in four levels: proximal, middle, crura of penis and intra-cavernous. The intra-cavernous communications are responsible for autonomic fibers observed in the dorsal nerves of the penis.Conclusion: Our results show a large number of vascular and nerve anastomoses in the corpora cavernosa between supra and infralevator sustems with two distinct anatomical regions: the 2/3 proximal erectile portion and 1/3 distal sensorial portion. These anastomoses provide a hope for the plasticity in the vascularization and innervation of the penis in cases of erectile dysfunction.

No description available.

Dans cette thèse, nous avons travaillé sur les différents versants de la technique de dissection sous-muqueuse et les problèmes que pose ce geste quasi chirurgical dans des unités d'endoscopie initialement médicales. Tout d'abord, nous avons travaillé sur la formation à la technique en développant un modèle d'apprentissage sur colon de bovin plus adapté à la situation européenne où les lésions colo-rectales sont les plus fréquentes. Ce modèle de rectum de bovin, simple à trouver et à préparer permet une formation dans des conditions plus proches de la paroi colique humaine que celles offertes par l'estomac de cochon. Un travail à plus grande échelle évaluant les bénéfices d'une aide à l'apprentissage par un logiciel interactif dédié mené sur ce modèle avec 37 étudiants français et japonais est en cours d'analyse et sera publié prochainement. Ensuite, nous avons réfléchi à la stratégie de la procédure pour la rendre plus simple en évaluant précocement la technique du tunnel pour la dissection des lésions œsophagiennes. Cette stratégie permet de maintenir une traction sur les bords lésionnels et nous offrent une sorte de triangulation en élargissant physiquement la zone de travail. Cette stratégie est devenue un standard pour les résections œsophagiennes dans de nombreuses équipes. Enfin, nous avons travaillé conjointement avec la société Nestis® au développement d'un outil permettant d'optimiser la procédure de dissection sous-muqueuse en associant les bénéfices des bistouris bi fonction (injectant et coupant avec le même outil}, de la haute pression pulsée et des solutions macromoléculaires visqueuses. Le système Nestis® permet pour la première fois cette association et a démontré son intérêt en termes de sécurité et de performance par rapport à la méthode classique utilisant l'aiguille et un bistouri électrique conventionnel. Avec cet outil bi fonction, il n'est plus nécessaire de changer d'instrument puisque toutes les étapes de la procédure sont désormais réalisées avec un seul et même outil. D'autres projets sont déjà prévus avec ce matériel pour étudier ses bénéfices et sa sécurité en dissection colique humaine qui est réputée comme la plus difficile compte tenu de la finesse de la paroi. Enfin, ce matériel offre la possibilité d'injecter sous pression des principes actifs qui pourrait dans le futur permettre de prévenir la survenue de sténoses œsophagiennes ou diriger la cicatrisation. Nous avons ainsi travailler avec la pharmacie de l'hôpital Edouard Herriot pour stabiliser la solution macromoléculaires de mélange de glycérol pour permettre son utilisation en pratique quotidienne / First of all, we worked on the training for unexperienced operators by developing a bovine colon model more adapted to the European situation where colo-rectal lesions are the most common. This model of rectum from bovine, easy to find and to prepare allows training in conditions most close to the human colonic wall than those offered by the pig stomach. Furthermore, such models allows to teach the initial skills but avoiding the risk of adverse events for the first procedures in humans. A future work evaluating the benefits of a learning support by a dedicated interactive software on this model with 37 french and Japanese students is now being analyzed and will be reported soon. Then we thought about the strategy of the procedure in order to make it more simple using the tunnel technique to perform ESD for the esophageal lesions. This strategy helps to maintain traction on the edges and offers a sort of triangulation physically expanding the working space. This strategy has become a standard for esophageal resections in many teams and we still work to improve its efficacy. Finally, we worked jointly with Nestis® Company to develop a tool to optimize the submucosal dissection procedure by combining the benefits of the catheters bi function (injecting and cutting with the same tool), but adding high pulsed pressure and capability to inject viscous macromolecular solutions. The Nestis® system allows for the first time this association and demonstrated his interest in terms of security and performance compared with the conventional method using the needle and a conventional electrocautery device. With this bi function tool, it is not necessary to change instrument frequently since all stages of the procedure are now done with a single device. Other projects are already included with this material to explore its benefits and its safety in human colonic dissection that is deemed as the most difficult due to the thinner wall. Finally, this material offers the possibility to inject pressurized active drugs which could be used in the future to prevent the occurrence of esophageal strictures or to direct healing. We also worked with the hospital Edouard Herriot pharmacy to stabilize the solution glycerol mix to allow its use in daily practice in our unit

Introduction: Parmi les structures anatomiques impliquées dans les fonctions génitales et urinaires, l’innervation autonome et somatique du rétro-péritoine, du pelvis et du périnée a un rôle contrôle déterminant. Cette innervation reste incomplètement systématisée et elle apparaît vulnérable lors d’interventions chirurgicales ou au cours de maladies neurologiques. Classiquement, deux voies nerveuses se situent de part et d’autre du muscle élévateur de l’anus (MEA) : la voie autonome est supra-lévatorienne ; la voie somatique est infra-lévatorienne. Les nerfs autonomes viennent du plexus hypogastrique supérieur (PHS) (fibres sympathiques) qui se divise en deux nerfs hypogastriques (NHs) s’engageant dans le pelvis. Les NHs reçoivent des nerfs splanchniques pelviens (fibres parasympathiques) qui forment le plexus hypogastrique inférieur (PHI). Les voies somatiques proviennent des nerfs pudendaux. Ces notions établies par la dissection conventionnelle peuvent aujourd’hui être complétées par l’analyse de marqueurs nerveux en Dissection Anatomique Assisté par Ordinateur (DAAO). Celle-ci est susceptible de préciser les connaissances anatomiques et d’éclairer la compréhension des dysfonctions génito-urinaires.Objectifs: L’objectif était de décrire le système nerveux autonome rétro-péritonéal et pelvi-périnéal dans ses aspects morphologiques (origine, topographie, trajet, rapports) et fonctionnels (nature des fibres, terminaisons viscérales) pour mettre en perspective les implications potentielles dans les dysfonctions génito-urinaires.Matériel et méthodes: Des coupes histologiques sériées de 5 µm d’épaisseur ont été effectuées dans les régions lombaire et pelvienne de onze fœtus humains âgés de 14 à 31 semaines de gestation, et au niveau pénien chez cinq sujets anatomiques adultes masculins. Pour chaque niveau de coupe, des lames ont été colorées puis traitées en immunohistochimie pour détecter : l’ensemble des fibres nerveuses (anticorps anti-protéine S100), les fibres nerveuses somatiques (anti-PMP 22), les fibres autonomes adrénergiques (anti-TH), les fibres autonomes cholinergiques (anti-VAChT), les fibres autonomes nitrergiques (anti-nNOS), et les fibres musculaires lisses (anti-actine lisse). Les coupes ont ensuite été numérisées par un scanner de haute résolution optique et les images ont été reconstruites en 3D avec le logiciel Winsurf®.Résultats: Au niveau rétro-péritonéal, le PHS est formé de fibres adrénergiques, cholinergiques et nitrergiques. Ses fibres proviennent à la fois du plexus mésentérique inférieur, des ganglions sympathiques voisins et des nerfs splanchniques lombaires. Au niveau pelvien, le PHI se systématise en : une portion supérieure recevant ses fibres du PHS et innervant détrusor, uretères et vésicales séminales ; une portion inférieure recevant ses fibres des nerfs splanchniques pelviens et innervant trigone, prostate et corps érectiles. La jonction uretéro-vésicale est une zone richement innervée par des fibres adrénergiques, cholinergiques et nitrergiques provenant du PHI et des NHs. En outre, le PHI fournit un contingent nerveux autonome au MEA par voie supra-lévatorienne, tandis que le nerf pudendal (NP) lui fournit un contingent somatique par voie infra-lévatorienne. Au niveau pénien, la composante autonome prédomine dans les 2 tiers proximaux quand, en distalité, l’innervation est presque exclusivement somatique. Trois niveaux de communication entre les voies autonome et somatique ont été observés : pré- trans- et post-lévatorien.Conclusion: L’intrication des voies autonomes et somatiques rétropéritonéo-pelvi-périnéales, la diversité de leurs origines, leurs communications et répartition depuis les plexus jusqu’aux viscères s’établissent par DAAO. Ces voies méritent d’être au mieux préservées au cours d’interventions chirurgicales ou instrumentales. Elles représentent de potentielles voies de modulation, de plasticité ou de régénération à explorer. / Introduction: The autonomous and somatic innervations of the retro-peritoneum, the pelvis and the perineum have a determining control role among the anatomical structures involved in the genital and urinary functions. The innervations remain incompletely systematized and appear vulnerable during surgical procedures or during neurological diseases. Normally, two nerve pathways are located on both side of levator ani muscle (LAM): the autonomic pathway is supra-levatorian and the somatic pathway is infra-Levatorian. The autonomic nerves come from the superior hypogastric plexus (SHP) (sympathetic fibers) which divides into two hypogastric nerves (HNs) engaging in the pelvis. The HNs receive pelvic splanchnic nerves (parasympathetic fibers) which form the inferior hypogastric plexus (IHP). The somatic pathways come from the pudendal nerves. These notions which are established by conventional dissection can now be supplemented by the analysis of nerve markers in computer-assisted anatomic dissection (CAAD). This is likely to clarify anatomical knowledge and illuminate the understanding of genitourinary dysfunction.Objectives: The objective of this study was to describe the retro peritoneal and pelvic -perineal autonomic nervous system, its morphological (origin, topography, path and relationships) and functional (nature of fibers, visceral endings) aspects and to put into perspective the potential implications on genitourinary dysfunction.Materials and methods: Serial histological sections of 5 μm of thickness were performed in the lumbar and pelvic regions of eleven human fetuses aged 14 to 31 weeks of gestation and at the penile level in five male adult anatomical subjects. For each level, slides were stained and then treated in immunohistochemistry to detect: general nerve fibers (anti-protein S100), somatic nerve fibers (anti-peripheral myelin protein 22), autonomic adrenergic fibers (anti-tyrosine hydroxylase), autonomic cholinergic fibers (anti-VAChT), autonomic nitrergic fibers (anti-nNOS), and smooth muscle fibers (anti-actin). The slides were then digitized by a high-resolution optical scanner and the images were reconstructed in 3D using the Winsurf® software.Results: At the retroperitoneal level, the SHP is composed of adrenergic, cholinergic and nitrergic fibers. Its fibers come from inferior mesenteric plexus, the adjacent ganglions and the lumbar splanchnic nerves. At the pelvic level, the IHP is systematized into: a superior portion receiving its fibers of the SHP and innervating detrusor, ureters and seminal vesicles, a inferior portion receiving its fibers from the pelvic splanchnic nerves and innervating trigone of bladder, prostate and erectile bodies. The ureterovesical junction is an area richly innervated by adrenergic, cholinergic and nitrergic fibers from the IHP and the HNs. In addition, the IHP provides an autonomic nervous to the LAM via the supra-levatorian route, while the pudendal nerve provides a infra-levatorian somatic nervous. At the penile level, the autonomic component predominately innervates in the proximal two thirds where, in distal third, the innervation is almost exclusively somatic. Three levels of communications between the autonomic and somatic pathways were observed: pre- trans- and post-levatorian.Conclusions: The interaction of the autonomic and somatic retroperitoneo-pelvic-perineal pathways, the diversity of their origins, their communications and distribution from the plexus to the viscera are established by CAAD. These pathways deserve to be best preserved during surgical or instrumental procedures. They represent potential pathways of modulation, plasticity or regeneration to be explored in future studies.