Current Advances in Pelvic Splanchnic Innervation Research for Pelvic Organ Prolapse and Stress Urinary Incontinence: A Systematic Review

Introduction: Despite elusive consensus regarding the pelvic splanchnic nerve’s (PSN) mechanistic contributions to pelvic floor dysfunction (PFD), emerging evidence implicates its regulatory role in pelvic organ prolapse (POP) and stress urinary incontinence (SUI). This systematic review synthesizes current understanding of PSN pathophysiology through mechanistic analyses, animal model paradigms, diagnostic methodologies, and translational research trajectories. Methods: A systematic literature search (PubMed/CNKI through 20-Jan-2024) employed dual-reviewer protocol with predefined inclusion criteria. Data extraction encompassed study design, experimental models, temporal parameters, assessment modalities, and key findings. Methodological rigor followed PRISMA guidelines for evidence synthesis. The systematic review has been registered in PROSPERO (CRD42024505013). Results: Analysis of 61 qualified studies (32 preclinical, 12 histopathological, 17 clinical) identified two validated animal models: vaginal distension (VD) and pudendal nerve transection (PNT). Furthermore，neuromodulation therapies demonstrated efficacy across multiple studies, including: Sacral neuromodulation (SNM)，Electroacupuncture (EA)，Transcutaneous mechanical nerve stimulation (TMNS)，Electrical pudendal nerve stimulation (EPNS). Conclusions: While PSN’s precise pathomechanisms in POP require further elucidation, current evidence establishes strong associations between PSN integrity and POP/SUI pathogenesis, though molecular mediators remain undefined. This highlighting a direction that demands additional endeavors and potentially necessitates further relevant experimental studies for validation.