Internal Pudendal Artery Research Articles

Erectile dysfunction in heart failure rats is associated with increased neurogenic contractions in cavernous tissue and internal pudendal artery

The rates of erectile dysfunction (ED) in heart failure (HF) are extremely high. This study tested the hypothesis that rats with HF display ED and that HF leads to increased sympathetic-mediated contractile tone of the cavernous tissue and/or internal pudendal arteries (IPA) as potential mechanisms contributing to ED. HF was induced in Wistar rats by ligation of the left anterior descending coronary artery. Changes in the ratio of intracavernosal pressure/mean arterial pressure (ICP/MAP) after electrical stimulation of major pelvic ganglion were determined in vivo. Cavernosal and IPA contractions were induced by electric field stimulation (EFS) and phenylephrine. RhoA, Rho kinase 2 (ROCK 2) and myosin phosphatase target protein 1 (MYPT-1) protein expression and phosphorylation levels were also determined. HF rats display impaired erectile function represented by decreased ICP/MAP responses. EFS-mediated contractions were increased by HF in cavernous tissue and IPA. Contractions induced by phenylephrine were increased in cavernous tissue of HF rats, but decreased in IPA rings. Moreover, HF decreased RhoA protein expression, but increased ROCK 2 and MYPT-1 phosphorylation levels in cavernous tissue. In conclusion, rats with HF induced by myocardial infarction display ED in vivo and increased sympathetic-mediated contractile responses in cavernous tissue and IPA. Increased sympathetic-mediated contractile responses were associated with increased ROCK 2 and MYPT-1 phosphorylation in cavernosal tissue, suggesting the involvement of ROCK signaling pathway in ED genesis. Our findings suggest new mechanisms linking HF to ED, providing potential therapeutic targets for treating ED associated to HF.

Anatomy and arterial vascularization of female genital system of margay (Leopardus weidii)

The margay (Leopardus wiedii) belongs to Carnivora order and present’s nocturnal habits. There are few studies using this specie, whereas it is between feline species vulnerable to extinction. Thus, we propose a descriptive study about female genital system and behavior of the arteries responsible for the blood supply to these organs in margay. It used one exemplary victim of poaching that to death. The animal was stored in freezer. Subsequent to defrost at room temperature, it proceeded with the solution injection Leoprene Latex ‘650’ colored in red for better identification of vessels before the adjacent strutures. The specimen was fixed using an aqueous 10% formaldehyde with subsequent immersion in the same fixative solution. The genital system were dissected and the organs and arterial branches were identified and photodocumented. The female genital system of margay consists of a pair of ovaries, uterus with a pair of uterine horns, vagina and vulva. The arterial distribution of female system have a common vessel to iliac artery which branches and leads to internal pudendal artery sends a branch along the pudendal nerve pathway, urogenital artery. This, we performed divided into two branches, cranial and caudal. The cranial branch irrigates laterally cervix and uterine horns and caudal branch, vagina and vulva. The ovarian arteries, peers, originate from abdominal aorta only vascularization the ovaries. The female genital system and vascularization of the genitals organs of margay resembles of domestic carnivores including cats and some wild felines like the ocelot and find differences with the same description held in other domestic and wild species. https://doi.galoa.com.br/doi/10.17648/jibi-2448-0002-1-1-4163

Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin

Purpose: To determine the specific lesion pattern of supplying arteries in patients with cardiovascular risk factors suffering from treatment-refractory erectile dysfunction (ED). Methods: From May 2012 to August 2013, 26 men (median age 55 years) poorly responsive to phosphodiesterase-5 inhibitor therapy were evaluated for a possible vascular cause for their ED. The men were examined with penile duplex sonography and digital subtraction angiography (DSA). Arterial lesions in the common and internal iliac arteries and the internal pudendal arteries considered amenable to endovascular therapy were treated with angioplasty ± stents. Retrospectively, 2 blinded investigators independently evaluated the DSA images and categorized the vascular patterns of the erection-related arteries as normal, macroangiopathy (occlusive lesions of the internal pudendal arteries), or microangiopathy (smaller caliber arteries distal to the internal pudendal circulation with no distal arterial reconstitution). Results: Seventeen macroangiopathic lesions were successfully treated by angioplasty in 11 patients. The treated arterial lesions were mainly located in the internal (n=10) and common iliac arteries (n=2), whereas the internal pudendal artery were involved in 5 cases. Microangiopathic lesions lacking distal reconstitution were present in 7 patients, and the remaining 8 patients had normal vessels supplying the penis. Patients with macroangiopathy undergoing angioplasty had a higher prevalence of peripheral artery disease (63.6% vs 6.7%, p=0.003). Conclusion: In this preliminary series of ED patients with cardiovascular risk factors and pathologic duplex sonographic flow parameters, roughly 40% exhibited arterial lesions amenable to endovascular revascularization. In the patients with macroangiopathy, vessels upstream of the internal pudendal artery were most commonly affected. More studies are warranted to define the role of endovascular procedures in this ED subpopulation.

Abstract 014: Nox1-derived ROS Impairs Internal Pudendal Artery Function via Nrf2 and Rho Kinase in Diabetic Mice

Oxidative stress plays an important role in vascular dysfunction in diabetes, an important risk factor for erectile dysfunction (ED). Functional and structural changes in internal pudendal arteries (IPAs), which provide blood supply to the corpus cavernosum, can lead to ED. We hypothesized that downregulation of Nrf2-regulated enzymes, consequent to increased NOX1-derived ROS, impairs IPAs function in diabetic mice. IPAs and cultured vascular smooth muscle cells (VSMC) from C57BL/6 (control) and NOX1 knockout (KO) mice were used; diabetes (DM) was induced by streptozotocin in C57BL/6 mice. Vascular function assessment, by wire myography, demonstrated that IPAs from diabetic mice displayed increased contractility to phenylephrine (Phe, Emax: control 138.5±9.5 vs. DM 191.8±15.5) and decreased endothelial-dependent relaxation to acetylcholine (ACh, Emax: control 98.3±2.65 vs. DM 76.1±4.5). These responses were corrected by incubation of IPAs with tiron (ROS scavenger), bardoxolone (Nrf2 activator), ML171 (NOX1 inhibitor) and Y27632 (Rho Kinase inhibitor). IPAs from diabetic mice exhibited decreased Y276732-induced vasodilatation (LogEC50: control 5.8±0.1 vs. DM 5.3±0.1). Cultured VSMC from IPAs, maintained in high glucose (HG) medium, displayed increased levels of superoxide anion (59.6%±10.43) and nitrotyrosine (40.8%±9.8), as well as decreased NO production (37.7%±10.42) and nuclear accumulation of Nrf2 (20.42%±3.6), effects not observed in VSMC from IPAs isolated from NOX1 KO mice. The expression of Nrf2-regulated genes was also decreased in VSMC from IPAs maintained in HG [catalase (25.6%±0.05), HO-1 (21%±0.1) and NQO-1 (22%±0.1)], an effect prevented by the incubation with ML171. HG decreased H2O2 levels in control VSMC (29%±5.0), but increased H2O2 in NOX1 KO VSMC (45.8%±7.1), effects not observed when cells were pre-incubated with GKT 137831 (NOX1/4 inhibitor). In conclusion, diabetes-associated IPAs dysfunction involves increased NOX-1 derived ROS, decreased expression of Nrf2-regulated enzymes and activation of the Rho kinase pathway. These data suggest that Nrf2 may be vasoprotective in diabetes-associated ED. Financial Support: FAPESP, Brazil.

Radiological Findings of Prostatic Arterial Anatomy for Prostatic Arterial Embolization: Preliminary Study in 55 Chinese Patients with Benign Prostatic Hyperplasia.

ObjectiveTo describe the prostatic arterial supply using Cone-beam computed tomography (CT) and digital subtraction angiography (DSA) before prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH).MethodsIn a retrospective study from January 2012 to January 2014, 55 male patients (110 hemipelves) with BPH who underwent PAE were evaluated by Cone-beam CT in addition to pelvic DSA during embolization planning. Each hemipelvis was evaluated regarding the number of prostatic arteries (PA) and their origins, diameters, territorial perfusion, and anastomoses with adjacent arteries.ResultsA total of 114 PAs were identified in 110 hemipelves. There was one PA in 96.4% of the hemipelves (n=106), and two independent PAs in the other 3.6% (n=4). The PA was found to originate from the anterior trunk of the internal iliac artery in 39.5% of cases (n=45) , from the superior vesical artery in 32.6% (n=37), and from the internal pudendal artery in 27.9% of cases (n=32). Extra-prostatic anastomoses between PA and adjacent arteries were found in 39.1% of hemipelves (n=43). Intra-prostatic anastomoses between PAs and contra-lateral prostatic branches were found in 61.8% of hemipelves (n=68). In 67.3% of our study population (n=37), the prostate was dominantly supplied via a unilateral PA.ConclusionThe prostatic vascularization is complex with frequent anatomic variations. Knowledge of the vascular anatomy of the prostate may provide indications for planning PAE and avoiding nontarget embolization.

A Cadaveric Study of the Arterial Blood Supply of the Labia Minora.

Labiaplasty has become a rather common operation. The main complication of the different surgical techniques is the dehiscence of the suture line. The dehiscence rate varies among the different techniques, and this may imply that the vascular anatomy is not respected in some cases. The detailed arterial anatomy of labia minora is not well described, so the aim of the authors was to describe this anatomy with a cadaveric study. Eleven fresh cadavers were dissected, and arterial study was made with injected computed tomography scans and rotational angiography. At the end, a cast of the arterial network was made and chemically exposed to verify the radiological findings. The findings of this study allowed identification of a dominant central artery that was named "C" artery, two posterior arteries named "P1" and "P2," and one small anterior artery, "A." Furthermore, a connection between the anterior system of the external pudendal artery and the posterior system of the internal pudendal artery was confirmed. The arterial network of the labia minora was identified with this study. This may help surgeons orientate the wedge excision when they perform labiaplasties. More precisely, when this wedge is placed at the most anterior part of the labia minora, the least perfused area is removed, and a posterior flap is created that will preserve a robust blood perfusion.

SU‐E‐J‐181: Effect of Prostate Motion On Combined Brachytherapy and External Beam Dose Based On Daily Motion of the Prostate

Purpose:In this study, the adequacy of target expansions on the combined external beam and implant dose was examined based on the measured daily motion of the prostate.Methods:Thirty patients received an I–125 prostate implant prescribed to dose of 90Gy. This was followed by external beam to deliver a dose of 90Gyeq (external beam equivalent) to the prostate over 25 to 30 fractions. An ideal IMRT plan was developed by optimizing the external beam dose based on the delivered implant dose. The implant dose was converted to an equivalent external beam dose using the linear quadratic model. Patients were set up on the treatment table by daily orthogonal imaging and aligning the marker seeds in the prostate. Orthogonal images were obtained at the end of treatment to assess prostate intrafraction motion. Based on the observed motion of the markers between the initial and final images, 5 individual plans showing the actual dose delivered to the patient were calculated. A final true dose distribution was established based on summing the implant dose and the 5 external beam plans. Dose to the prostate, seminal vesicles, lymphnodes and normal tissues, rectal wall, urethra and lower sphincter were calculated and compared to ideal. On 18 patients who were sexually active, dose to the corpus cavernosum and internal pudendal artery was also calculated.Results:The average prostate motion in 3 orthogonal directions was less than 1 mm with a standard deviation of less than +2 mm. Dose and volume parameters showed that there was no decrease in dose to the targets and a marginal decrease in dose to in normal tissues.Conclusion:Dose delivered by seed implant moves with the prostate, decreasing the impact of intrafractions dose movement on actual dose delivered. Combined brachytherapy and external beam dose delivered to the prostate was not sensitive to prostate motion.

Pelvic Arterial Anatomy Relevant to Prostatic Artery Embolisation and Proposal for Angiographic Classification.

To describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure. Angiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage. Two hundred eighty-six pelvic sides (n = 286) were analyzed, and 267 (93.3%) were classified into I-IV types. Among them, the most common origin was type IV (n = 89, 31.1%), followed by type I (n = 82, 28.7%), type III (n = 54, 18.9%), and type II (n = 42, 14.7%). Type V anatomy was seen in 16 cases (5.6%). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0%). Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95% of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.

The Ups and Downs of Aging in the Male Genitourinary Tract

Lower urinary tract symptoms (LUTS), are a collection of filling, storage, voiding and postmicturition symptoms highly prevalent and negatively impacting the quality of life of aging men. These symptoms are commonly caused by benign prostatic hyperplasia (BPH), and additional risk factors include obesity, diabetes, hypercholesteremia and hypertension. In order to understand the pathological changes that occur in the lower male genitourinary (GU) tract, it is important to review the normal anatomy, physiology, vascular and neural control of the bladder, prostate and penis. Significant alterations in the male GU tract with aging manifest as impairments in physiological functions such as blood flow, neuropathy, fibrosis, and hypertrophy. Prostate enlargement (BPH) with bladder outlet obstruction due to dynamic and statics factors such as smooth muscle cell hyperplasia impair bladder emptying and promote dysfunction. Sexual dysfunction is highly prevalent and results from loss of compliance of the penile sinusoids associated with increased deposition of collagen, decreased elastic fibers, endothelial dysfunction, and neuropathy. Additionally, aging and cardiovascular disease can impair the structure and function of the internal pudendal arteries which supply blood to the penis during an erection. Understanding the changes in anatomy, the symptoms associated with impaired lower GU function and disease‐specific therapies for these conditions will no doubt improve the care and quality of life for our aging male population.

PD36-02 INCREASED VASCULAR REMODELING AND CALCIFICATION OF CORONARY AND INTERNAL PUDENDAL ARTERIES FROM MEN WITH CARDIOVASCULAR DISEASE

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research II1 Apr 2015PD36-02 INCREASED VASCULAR REMODELING AND CALCIFICATION OF CORONARY AND INTERNAL PUDENDAL ARTERIES FROM MEN WITH CARDIOVASCULAR DISEASE Johanna L. Hannan, Jesse M. Hall, Jacob M. Fox, Patrick M. Kennedy, Mackenzie J. Clarkson, H Wayne Lambert, and Trinity J. Bivalacqua Johanna L. HannanJohanna L. Hannan More articles by this author , Jesse M. HallJesse M. Hall More articles by this author , Jacob M. FoxJacob M. Fox More articles by this author , Patrick M. KennedyPatrick M. Kennedy More articles by this author , Mackenzie J. ClarksonMackenzie J. Clarkson More articles by this author , H Wayne LambertH Wayne Lambert More articles by this author , and Trinity J. BivalacquaTrinity J. Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2251AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have improved erectile function in atherosclerotic patients by stenting the internal pudendal artery (IPA); however a third of these patients have restenosis after 6 months. In animal models, the IPA develops endothelial dysfunction, remodels and calcifies before other similar sized resistance vessels but this has not been examined in men. This study will characterize the morphology, and calcium and phosphate content of coronary arteries (CA) and IPA from male cadavers with and without cardiovascular disease (CVD). METHODS The CAs and IPAs were dissected from formalin fixed male cadavers (n=31, 49-86 years old) who had died from CVD, natural causes or cancer. Arterial segments (5mm) taken from the distal IPA (prior to dorsal artery), proximal IPA (prior to rectal artery), and CA (middle of main branch) were paraffin embedded, sectioned and stained with Masson's trichrome. Lumen diameter, wall thickness, and wall-to-lumen ratio were measured. Additional arterial segments were used to measure calcium and phosphate content. RESULTS Overall, the CA had a larger lumen diameter than the IPAs which tapered as they travelled distally towards the penis (2.6±0.18; 1.9±0.12mm; 1.2±0.09, p<0.05). The wall-to-lumen ratio was drastically increased in the distal IPA (0.84±0.28) compared to the proximal IPA (0.30±0.03) and CA (0.33±0.07). The CA from men with CVD had significantly smaller lumen diameters (2.3±0.14, 3.4±0.44mm, p<0.05) with similar wall thicknesses to men without CVD. Interestingly, both segments of the IPA were no different in morphology between men with or without CVD. This suggests that the IPAs have already undergone remodeling prior to the CAs in men without CVD. The CA calcium content was also elevated in men with CVD (0.92±0.49 vs 0.10±0.05mmol/mg, p<0.05) whereas there was no difference in the distal IPA (0.65±0.23 vs 0.44±0.14mmol/mg). The phosphate findings in all vessels paralleled the calcium content linearly. CONCLUSIONS This is the first study to characterize the morphological changes in CAs and IPAs from male cadavers. While there were obvious differences in the CA from men with and without CVDs, the IPAs from all men had similar pathological remodeling independent of underlying disease. This outlines the importance of the IPA and provides further evidence of a causative role of vascular structural changes in aging-induced erectile dysfunction. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e765 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johanna L. Hannan More articles by this author Jesse M. Hall More articles by this author Jacob M. Fox More articles by this author Patrick M. Kennedy More articles by this author Mackenzie J. Clarkson More articles by this author H Wayne Lambert More articles by this author Trinity J. Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD40-01 3 YEAR OUTCOMES OF THE ZEN TRIAL: THE MEDTRONIC ZOTAROLIMUS-ELUTING PERIPHERAL STENT SYSTEM FOR THE TREATMENT OF ED IN MALES WITH SUB-OPTIMAL RESPONSE TO PDE5 INHIBITORS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-01 3 YEAR OUTCOMES OF THE ZEN TRIAL: THE MEDTRONIC ZOTAROLIMUS-ELUTING PERIPHERAL STENT SYSTEM FOR THE TREATMENT OF ED IN MALES WITH SUB-OPTIMAL RESPONSE TO PDE5 INHIBITORS Tobias Kohler and Irwin Goldstein Tobias KohlerTobias Kohler More articles by this author and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2435AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We report 3 year safety, feasibility and outcomes of zotarolimus−eluting stent implantation in focal atherosclerotic lesions of the internal pudendal arteries (IPAs) among men with erectile dysfunction (ED) and a suboptimal response to phosphodiesterase−5 inhibitors. METHODS We performed a prospective, multicenter, single-armed safety and feasibility trial of 30 male subjects > 18 years with atherosclerotic ED and a suboptimal response to phosphodiesterase-5 inhibitors. A novel combination of clinical, duplex ultrasound, and invasive angiographic factors were used to determine eligibility for stent therapy. Key inclusion criteria included IIEF-6 < 21 with at least 4 weeks of PDE5i use, ultrasound PSVs < 30 cm/sec bilaterally, and angiographic stenosis of one or both IPAs. Key exclusion criteria included non-vascular causes of ED, venous leak as seen on penile Doppler (EDV > 5 cm/sec), and non target lesions of > 70% stenosis in common iliac or common penile artery. The primary safety end point was any major adverse event 30 days after the procedure. The primary feasibility end point was improvement in the IIEF-6 (Erectile Dysfunction Domain) score of 4 points or more. RESULTS A total of 383 subjects were screened of which there was a 92% screen failure rate. Forty-five lesions were treated with stents in 30 subjects. Procedural success was 100% with no major adverse events through follow-up. The primary feasibility end point (IIEF-6 +4) was achieved by 81% of intention-to treat subjects (17/21) at 1 year, 58% (11/19) at 2 years and 39% (5/13) at three years. 5 patients were stented outside the pudendal artery. Per protocol outcomes revealed IIEF improvement by 4 points in 84% (16/19)at 1 year, 61% (11/18) at 2 years and 36% (4/11) at 3 years. Changes in IIEF6 scores from baseline for the per protocol group were + 18.6 (95% CI = 11.8-25.5) at one year, + 14.7 (6.3-23.2) at 2 years, and + 7.8 at 3 years (-0.3 - 16). Mean peak systolic velocity on penile Doppler increased from 16.4 cm/s at baseline to 32.4 cm/sec at 1 year. Angiographic binary restonosis (>50% lumen diameter stenosis) was found in 11/32 lesions (34.4%). CONCLUSIONS Among patients with ED and limited response with pharmacologic therapy, percutaneous stent revascularization of the internal pudendal artery is safe and appears promising. However, significant challenges remain in determining and screening for the appropriate patient treatment population, optimizing procedural techniques for placement, and preventing stent restenosis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e835 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tobias Kohler More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pudendal Nerve and Internal Pudendal Artery Damage May Contribute to Radiation-Induced Erectile Dysfunction

Erectile dysfunction is common after radiation therapy for prostate cancer; yet, the etiopathology of radiation-induced erectile dysfunction (RI-ED) remains poorly understood. A novel animal model was developed to study RI-ED, wherein stereotactic body radiation therapy (SBRT) was used to irradiate the prostate, neurovascular bundles (NVB), and penile bulb (PB) of dogs. The purpose was to describe vascular and neurogenic injuries after the irradiation of only the NVB or the PB, and after irradiation of all 3 sites (prostate, NVB, and PB) with varying doses of radiation. Dogs were treated with 50, 40, or 30 Gy to the prostate, NVB, and PB, or 50 Gy to either the NVB or the PB, by 5-fraction SBRT. Electrophysiologic studies of the pudendal nerve and bulbospongiosus muscles and ultrasound studies of pelvic perfusion were performed before and after SBRT. The results of these bioassays were correlated with histopathologic changes. SBRT caused slowing of the systolic rise time, which corresponded to decreased arterial patency. Alterations in the response of the internal pudendal artery to vasoactive drugs were observed, wherein SBRT caused a paradoxical response to papaverine, slowing the systolic rise time after 40 and 50 Gy; these changes appeared to have some dose dependency. The neurofilament content of penile nerves was also decreased at high doses and was more profound when the PB was irradiated than when the NVB was irradiated. These findings are coincident with slowing of motor nerve conduction velocities in the pudendal nerve after SBRT. This is the first report in which prostatic irradiation was shown to cause morphologic arterial damage that was coincident with altered internal pudendal arterial tone, and in which decreased motor function in the pudendal nerve was attributed to axonal degeneration and loss. Further investigation of the role played by damage to these structures in RI-ED is warranted.

The Vascular Supply of Hip Joint and its Clinical Significant

AL-TALALAH, WW . The vascular supply of hip joint and its clinical significant. Int. J. Morphol., 33(1):62-67, 2015.SUMMARY: The hip joint gains its vascular supply from the superior gluteal arteries as well as from the medial and lateralcircumflex femoral arteries with the first perforating artery. In gluteal trauma, the superior and inferior gluteal artery may be affectedwhich may end with vascular insult of hip joint. The current study includes a dissection of 171 cadavers to examine the vascula r supplyof hip joint. In 99.3% of articular branch arises from the superior gluteal artery either directly or indirectly (95.4% or in 3 .9%, respectively).In 81% of articular branch arises from the inferior gluteal artery either directly or indirectly in 78% or in 3%. In 20.3% of a rticular brancharises from the coexistence of sciatic artery either directly or indirectly (17.7% or in 2.6%, respectively). Infrequently, the internalpudendal artery gives articular branch in 0.4%. Further, there is no difference between male and female in hip joint supply in currentstudy. Based on current study’s result, the dominant articular branch of vascular supply of the hip joint comes from the superi or glutealartery whereas the inferior gluteal artery comes beyond due its congenital absence. The coexistence sciatic artery is a replace ment arteryfor superior or inferior gluteal artery in case of congenital absence. Due to aneurysm of the three previous arteries after trauma, it isimportant to study their course and articular branches to avoid iatrogenic fault of joint vascular insult during surgical management ofeither true or false aneurysm.KEY WORDS: Superior gluteal artery; Gluteal artery; Sciatic artery; Hip; Inferior gluteal artery; Persistent axial artery;Gluteal trauma; Iatrogenic fault of joint; Gluteal aneurysm, Rami comes nervi ischiadici; Articular branch.

Anatomical Variations of the Blood Vascular System in Veterinary Medicine. The Internal Iliac Artery of the Dog. Part Two.

The aim of this study was to investigate the variability of the internal pudendal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twenty-six anatomical variations were found, thirteen occurring in more than 5% of the dogs. Anatomical variations were grouped in relation to the origin of the prostatic/vaginal arteries, middle rectal artery, urethral artery, ventral perineal and caudal rectal arteries. The chi-squared test was used to analyse differences in sex, side of the body, profile and size, and the results were considered statistically significant when P ≤ 0.05. An identical vascular pattern in both hemipelvises was found for most of the anatomical variations described.

Pelvic magnetic resonance imaging angioanatomy of the arterial blood supply to the penis in suspected prostate cancer patients

PurposeTo describe the internal pudendal artery (IPA) and accessory pudendal artery (APA) detected by magnetic resonance (MR) angiography to help surgeons to find and preserve them during radical prostatectomy (RP). Materials and methodsConstrast-enhanced MR 3.0T angiography of the pelvis were performed in 111 male patients suspected diagnosis of prostate cancer (PCa), and describe the penile arterial blood supply. ResultsThere are three patterns of the arterial blood supply to the penis (IPA and/or APA) accounting for 51.4%, 46.8% and 1.8% of cases, respectively. About the accessory pudendal artery (APA): 54/111 (48.6%) patients had APA with five different branching patterns, they were type I (APA bilateral symmetry): 17 (31.5%); type II (APA bilateral asymmetry): 1 (1.9%); type III (APA unilateral lateral): 13 (24%); type IV (APA unilateral apical): 21 (38.9%); type V (APA unilateral mix): 2 (3.7%). APA origin were from inferior epigastric artery (IEA): 7 (9.5%); from inferior vesical artery (IVA): 32 (43.2%); from obturator artery (OA): 35 (47.3%). ConclusionA precise angioanatomic evalutation of arteries destined to the penis by MR angiography pre-operation for male pelvic organs will help surgeons to preserve them and contributes to reduce the erectile dysfunction after these procedures.

Internal pudendal perforator artery-based gull wing flap for vulvovaginal 3D reconstruction after tumour excision: a new flap.

Various skin tumours such as squamous cell carcinoma and extramammary Paget's disease can occur in the vulval area, and reconstruction of the vulval area can be a very challenging task. A retrospective analysis of vulvar reconstruction using the new method 'internal pudendal perforator artery-based gull wing flap' was performed from April 2012 to December 2013. A perforator vessel from the internal pudendal artery was detected with a portable Doppler and marked, and this was the pivot point around which the flap was rotated. The flap was rotated by more than 150°-180° internally, and the labium and the external wall of the vagina were reconstructed with sufficient volume. Anatomical and aesthetic reconstruction of the labium and the vagina was performed without serious complications. Functional and aesthetic vulvar reconstruction can be achieved by using a flap that provides sufficient volume of the labium. Our new technique, the 'internal pudendal perforator artery-based gull wing flap', is good and it can be used to reconstruct a functional and aesthetically acceptable vulvovagina for large defect wound after tumour excision.

Pedicle perforator flaps for vulvar reconstruction — New generation of less invasive vulvar reconstruction with favorable results

ObjectivesVulvar reconstruction after cancer surgery remains challenging. Pedicle perforator flaps are believed to be a less invasive option with better cosmesis. MethodsA retrospective review identified 27 flaps in 16 patients who underwent vulvar reconstruction after cancer surgery using island pedicled perforator flaps. Their average age was 55.7±17.8years (Range: 22–85). The average BMI was 23.5±4.0 (range: 18.8–28.5). Five of the 16 patients underwent unilateral vulvar reconstruction, and 11 of them underwent bilateral vulvar–perineal reconstructions. The perforator flaps included deep femoral (profunda) artery perforator (DFAP or PAP) flaps (n=11), medial circumflex femoral perforator (MCFAP) flaps (n=8), external pudendal artery perforator (EPAP) flaps (n=2), medial thigh free style perforator flaps (n=2), and internal pudendal artery perforator flaps (n=4). ResultsAll flaps survived with a 100% success rate. Three patients developed small wounds that required debridement and closure after the reconstruction. All donor sites were closed primarily. One patient developed temporary peroneal nerve palsy.During follow-up, none of the patients presented with donor site morbidities. All of the patients were satisfied with the cosmetic and functional results, except that one patient underwent a flap debulking procedure three months after surgery. ConclusionsCompared to traditional myocutaneous flaps, perforator flaps provide thinner fasciocutaneous flaps for vulvar reconstruction with favorable reconstruction results and fewer donor site morbidities. The medial or inner thigh is a region that is rich in perforators, which allow for more versatile flap design according to the defect. Furthermore, most of the donor site can be closed primarily without complications.

A Study of Variations in the Origin of Obturator Artery and its Clinical Significance.

The large number of organs and anatomical structures within the cramped pelvic cavity makes the study of vascular pattern and their variations of much importance in this particular anatomical region. Clear awareness of the vascular anatomy of pelvis is critical in surgeries performed here, which require ligation of the arteries concerned and also because such anomalous origins may cause profuse bleeding during surgical procedures. This is particularly true with regard to the variations in the origin of the obturator artery, while performing pelvic and groin surgeries. The aim of the present study was to find out the prevalence of normal and aberrant origins of obturator artery and to describe its surgical implications. The study was carried out on fifty hemipelvises of embalmed cadavers and the origin and course of the arteries were traced and noted. Of the 50 pelvic halves, in 27 specimens, the obturator took origin from the anterior division of internal iliac artery. Remaining 23 specimens showed variations. The origin of the obturator artery was from the inferior epigastric artery in 11 cases, from the common stem of the internal iliac artery and the external iliac artery in 2 cases each, from the posterior trunk of the internal iliac artery in 5 and one each from superior gluteal, inferior gluteal, and internal pudendal artery. The present study indicates that the origin of the obturator artery is highly variable. It can take origin from the stem of the internal iliac artery or from its anterior or posterior division, or from one of the branches of the divisions. It can also take origin from external iliac artery or its inferior epigastric branch. Advancements in diagnostic and surgical techniques in obstetric procedures and urogenital interventions make it essential to have a clear-cut understanding of the vasculature in the abdomen and pelvis.

Arterial Supply of Sciatic Nerve and Its Impact on Clinical Practice

Sciatic nerve is the nerve of the posterior compartment of thigh; it is formed in the pelvis from the ventral rami of L4 to S3 spinal nerves. It leaves the pelvis via the greater sciatic foramen below piriformis and divides into common peroneal nerve and tibial nerve at the level of the upper angle of the popliteal fossa. The vasculature of peripheral nerves is adapted specifically to their structure and function. Arterial vessels that reach main nerve trunks originate from the adjacent main arteries or their muscular or cutaneous branches. Although variability in arterial supply of sciatic nerve was discussed by some authors it is still deficient. To minimize sciatic nerve ischemia and its concomitant problems, an understanding of the origin and course of the arteries supplying it in the gluteal region and the posterior compartment of thigh is important. The present study aimed to detect the different arteries supplying the sciatic nerve in the gluteal and posterior thigh regions and to study the importance of this in clinical practice. Three cases subjected to vascular surgery and twenty lower limbs of ten formalin preserved male cadavers were used. Higher division of sciatic nerve was observed in all specimens. In 6 specimens (30%), arterial supply of sciatic nerve originated from the inferior gluteal artery, 6 specimens (30%)from first, second and third perforating arteries, 5 specimens (25%)from the lateral circumflex femoral artery and 3 specimens (15%)from internal pudendal artery. Anastomosis between internal iliac artery through its internal pudendal branch and external iliac artery through perforating arteries was observed. It was concluded that there is a good anastomosis between internal iliac and profunda femoris artery on the same side but cross pelvic anastomosis is absent or deficient and in case of profunda femoris occlusion we should preserve internal pudendal artery and the reverse.

Variability in the branching pattern of the internal iliac artery in Indian population and its clinical importance.

Internal iliac artery (IIA) is one of the terminal branches of the common iliac artery and is the prime artery of pelvis. The artery has many parietal and visceral branches and hence the variations are frequently noted. The larger branches, namely, the inferior gluteal artery, the superior gluteal artery, and the internal pudendal artery, show sufficient regularity in their patterns of origin to allow typing. The variability of the IIA and its branching pattern were studied by dissecting sixty-eight male pelvic halves (34 right and 34 left) and forty-eight female pelvic halves (24 right and 24 left sides). In significant number of specimens, IIA terminated without dividing into 2 trunks as against the usual description. There was also considerable interchange of branches between the 2 terminal divisions. The patterns of branching noted were grouped as per Adachi's classification. The incidence was noted to be as follows: type Ia in 60.6%, type Ib in 2.6%, type IIa in 15.8%, and type III in 21%. The other types were not observed in this study. Conclusion. Interventions in the pelvic region must take into account the variability of the IIA and its branches that can modify the expected relations and may lead to undesired hemorrhagic or embolic accidents.