A surgical injury to the presacral nerve (superior hypogastric plexus) during Hartmann's procedure leads to which functional deficit?

• A Loss of sympathetic ejaculation with preserved erection ✓
• B Loss of parasympathetic erection with preserved ejaculation
• C Urinary retention due to loss of detrusor contraction
• D Fecal incontinence due to loss of external anal sphincter tone

Explanation

The superior hypogastric plexus (presacral nerve) lies anterior to L5–S1 and carries sympathetic fibers responsible for seminal emission and ejaculation (coordinated sympathetic closure of the bladder neck plus contraction of seminal vesicles and vas deferens). Injury during rectal surgery causes retrograde ejaculation or dry orgasm. Erection is a parasympathetic function mediated by the pelvic splanchnic nerves (S2–S4/nervi erigentes), which are not in the presacral nerve. The external anal sphincter is somatic, innervated by the pudendal nerve from S2–S4.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.