Internal Pudendal Artery Research Articles

Case Report: Late Recurrent Hematuria following Laparoscopic Radical Prostatectomy May Predict Internal Pudendal Artery Pseudoaneurysm and Arteriovenous Fistula

We report two cases of a pseudoaneurysm of the internal pudendal artery with arteriovenous fistula after extraperitoneal laparoscopic radical prostatectomy. The clinical presentation was delayed recurrent hematuria and urinary retention that necessitated bladder clot evacuation. Subsequent arteriography detected the vascular abnormality and a superselective embolization was performed. Hematuria was no longer observed, and the quality of penile erection remains unchanged in both patients.

Three-dimensional Reconstructed Contrast–enhanced MR Angiography for Internal Iliac Artery Branch Visualization before Uterine Artery Embolization

To evaluate the feasibility of three-dimensional (3D) reconstructed contrast-enhanced (CE) magnetic resonance (MR) angiography in mapping the pelvic arteries in women before uterine artery embolization (UAE). CE MR angiography studies before UAE in 49 women (age range, 38-57 years; mean, 47.04 y +/- 4.7 [SD]) who underwent UAE for uterine leiomyomas between February 2005 and February 2007 were retrospectively evaluated by two radiologists in consensus. Studies were performed on a 1.5-T MR unit with a 3D fast low-angle shot sequence in the coronal direction. Reconstruction was performed with 3D computed tomographic angiography reconstruction software. In the current study, 98 internal iliac arteries (IIAs) from 49 women were studied. The superior and inferior gluteal arteries were visualized in all cases (N = 98; 100%), the lateral sacral artery in 86 cases (88%), the iliolumbar artery in 84 (86%), the obturator artery in 81 (83%), the internal pudendal artery in 96 (98%), and the uterine artery in 95 (97%). The superior vesical and middle rectal arteries were seen in 21 (21%) and 11 (11%) cases, respectively. The mean length of the uterine artery was 12.56 cm (range, 4.6-22.2 cm), and it showed the longest traceable length among all branches. The uterine artery showed five patterns of origin. The superior gluteal artery showed constant origin from the posterior division of the IIA, whereas the iliolumbar and obturator arteries showed the most variations in origin. Three-dimensional reconstructed CE MR angiography can detect most branches of the IIA in addition to their point of origin. Therefore, it can be used as a mapping tool of the pelvic arterial tree before UAE.

Transarterial embolization of a nonpuerperal traumatic vulvar hematoma

Nonpuerperal traumatic vulvar hematomas are relatively uncommon. Conservative and surgical management are the usual treatment options for traumatic vulvar hematomas. There is no report of transarterial embolization of nonpuerperal traumatic vulvar hematoma. We report a 35-year-old woman who presented with a vulvar hematoma caused by an accidental fall on a toy of her child. The hematoma was expanding and was refractory to conservative treatment. A computed tomography (CT) scan revealed active extravasation of contrast material from the left internal pudendal artery. We performed transarterial embolization of the left internal pudendal artery. The left external pudendal artery, which had an anastomosis with the left internal pudendal artery, was also embolized. Postembolization angiography demonstrated no further extravasation of contrast material. We believe that transarterial embolization can be an effective treatment of nonpuerperal traumatic vulvar hematomas when conservative treatment fails.

Angioarchitecture of the root of the equine penis

Equine penile vascular casts were prepared by perfusion with Batson's compound via the abdominal aorta in post mortem specimens of adult male ponies to clarify vascular features of the penile root (bulb and crura). Casts revealed vascular details of (1) the bulb and corpus spongiosum penis (CSP), the bulb having slightly larger diameter than the continuing CSP; (2) vascular spaces of the two crura, each with the proximal‐most part of the corpus cavernosum penis (CCP), and (3) proximal portion of the penile body, indicated by fusion of the two CCP. Each internal pudendal artery gave rise to only the artery of the bulb; there was no branch that supplied the CCP at the crus or that continued distally as the dorsal artery of the penis as found in other domestic mammals. The deep artery of the penis into the CCP for effecting penile erection was found to come solely from a branch of the obturator artery. In contrast to illustrations/descriptions in many veterinary anatomy atlases/texts, we were unable to demonstrate any anastomostic connections between the internal pudendal arterial and obturator arterial supply to the penile root. Multiple small, short veins passed from each crus to join the ipsilateral side of the plexiform dorsal vein at ischial arch level. Multiple small short veins rather than one large vein may enhance restriction of venous outflow from the crus during ischiocavernosus muscular contraction for erection.

Feasibility of Real-Time Ultrasound for Pudendal Nerve Block in Patients with Chronic Perineal Pain

Compared with conventional fluoroscopic-guided pudendal nerve block, ultrasonography has potential advantages for visualizing anatomical landmarks such as the internal pudendal artery and nerve, the sacrospinous and sacrotuberous ligaments, and local anesthetic spread. We examined the clinical utility of performing pudendal nerve block under real-time ultrasound guidance. Seventeen patients were studied. With the patient lying prone, a 2 to 5 MHz curved array ultrasound probe was placed at the level of the ischial spine to capture the transverse view of the ischial spine, the sacrospinous and sacrotuberous ligaments (SSL and STL), the internal pudendal artery (confirmed with color Doppler), and the pudendal nerve. A 22-gauge needle was advanced under real-time ultrasound guidance to reach the pudendal nerve in the plane between the STL and SSL. Following confirmation of spread of dextrose 5% solution in the interligamentous plane, a mixture of 5 mL 0.25% bupivacaine with 1:200,000 epinephrine and 40 mg Depo-Medrol (Pharmacia & Upjohn, Kalamazoo, MI) was injected. Assessment included the ease of identification of anatomical structures and local anesthetic spread with ultrasound, and the degree of sensory block in the perineum. The ischial spine, SSL, STL, internal pudendal artery, and pudendal nerve were easily identifiable with ultrasound in the majority of patients. Local anesthetic spread was seen as a hypoechoic collection around the nerve and expanding between the STL and SSL. All patients developed perineal sensory block following the procedure. Pudendal nerve block at the ischial spine level can be reliably performed under real-time ultrasound guidance.

Arterial supply to the sciatic nerve in the gluteal region

The arterial supply to the sciatic nerve was investigated in 20 human lower limbs (10 right, 10 left) from 20 cadavers (14 females, aged 84 +/- 9.6 years, range 66-95 years: 6 males, aged 80 +/- 8.2 years, range 70-90 years). In all limbs examined at least 1 sciatic artery could be identified supplying the sciatic nerve in the gluteal region. In total 28 sciatic arteries were identified, of which 14 arose from the medial circumflex femoral artery, 11 from the inferior gluteal artery, 2 from the first perforating artery, and 1 from the internal pudendal artery. In 5 limbs, 2 sciatic arteries were observed, being independent branches from the medial circumflex femoral and inferior gluteal arteries in 4 limbs and separate branches of the medial circumflex femoral artery in 1 limb. In 1 limb, 4 sciatic arteries were observed: 1 from the inferior gluteal artery, 2 from the medial circumflex femoral artery, and 1 from the first perforating artery. In the remaining 14 limbs a single sciatic artery was observed, which in one case arose from the internal pudendal artery, a previously unreported observation.

Neurovascular anatomy of the sacrospinous ligament region in female cadavers: Implications in sacrospinous ligament fixation

The objective of the study was to further characterize the anatomy of the coccygeus muscle-sacrospinous ligament (C-SSL) complex and to correlate the findings with sacrospinous ligament fixations (SSLF). Dissections were performed in 21 female cadavers. In all dissections, nerves originating from S3, S4, S5, or a combination passed over the anterior surface of the C-SSL at its midsegment, and either the pudendal or third sacral nerve coursed on the superior border of C-SSL at its midpoint. In 100% of specimens, the internal pudendal artery (IPA) passed behind or just medial to the ischial spine. The average distance of the inferior gluteal artery (IGA) from the ischial spine and the superior border of the C-SSL was 24.2 (range, 15-35) mm and 3.4 (range, 1-5) mm, respectively. Nerves to the coccygeus and levator ani coursed over the midportion of the C-SSL where SSLF sutures are placed. The pudendal nerve and IGA were in proximity to the superior border of the C-SSL at its midportion, whereas the IPA passed behind the ischial spine, lateral to the recommended site for suture placement.

Variations of the internal pudendal artery as a congenital contributing factor to age at onset of erectile dysfunction in Japanese

To investigate the relationship between variations of the pelvic artery arrangement and the age at erectile dysfunction (ED) onset, as some men develop ED while relatively young, while others maintain erectile function into old age despite having cardiovascular diseases, thus congenital factors might be involved. We examined 290 units of internal iliac arteries (IIA) in 145 patients showing repeated incomplete erectile response to intracavernosal injections with prostaglandin E(1). Patients with cardiovascular risk factors, neurological disease or pelvic injury were excluded. The pelvic artery arrangement, evaluated by three-dimensional computed tomographic angiography, was classified anatomically into five types: Type 1 (normal or basic type), in which the internal pudendal artery (IPA) originates from the anterior trunk at the level between the linea terminalis and the major ischial notch; Type 2, the IPA originates from the anterior trunk of the IIA at the level of the major ischial notch or more distally; Type 3, the IPA originates directly from the IIA at a level proximal to the linea terminalis; Type 4, the IPA originates together with the superior and inferior gluteal artery within 1 cm of each other; and Type 5, the penile blood supply is dependent on arteries other than the IPA, such as the obturator artery. Among the 290 units, eight could not be classified due to poor image quality. There were no statistically significant differences in blood flow parameters among the types of IIAs, but there was a statistically significant difference in the IPA type at the age of onset of ED. Type 1 (153 units or 53%) anatomy, was more common in patients who developed ED at an advanced age. Types 2, 3 and 4 were more common in patients with onset of ED at an early age (log-rank test P < 0.001, P = 0.044, P < 0.001, respectively). Compared with patients with the common type of IIAs bilaterally, patients with any of the variations bilaterally are at risk of early onset of ED (log-rank test: P = 0.002). In these anatomical studies, nearly half of all internal artery units are variations in type. Congenital factors might contribute to the development of ED. If a man has bilateral variation from the common type (Type 1), he might develop ED approximately 10 years earlier than those who are identical in every way except for their IPA (Type 1) arrangements.

Microcoil embolization of an arteriovenous fistula from the arteria bulbi penis to the corpus spongiosum penis in the treatment of erectile dysfunction: normal function regained immediately after intervention

A 39-year-old man presented with erectile dysfunction that had persisted since its sudden onset 5 years ago. He exhibited none of the classic risk factors, and all attempts at medication had been unsuccessful. An ultrasound examination revealed the presence of an arteriovenous shunt in the corpus spongiosum penis. Selective digital subtraction angiography of the left internal pudendal artery showed an arteriovenous fistula from the arteria bulbi penis to the corpus spongiosum penis. The outflow of venous blood took place via the penile veins into the periprostatic vein plexus. Superselective catheterization of the arteria bulbi penis was performed with a 3 French coaxial catheter (Topaz Micro Coils; Micro Therapeutics, Inc, Irvine, CA) and it was occluded by inserting several platinum coils. 1 week after the procedure, the patient reported normal erectile function, which was subsequently maintained.

Arterial Supply of the Penis in Agoutis (Dasyprocta prymnolpha, Wagler, 1831)

The arterial vascularization of agoutis' penis (Dasyprocta prymnolopha) were analysed using ten male adults from 'Núcleo de Estudos e Preservação de Animais Silvestres da Universidade Federal do Piauí' (FUFPI/IBAMA n degrees 02/99). Among the total number of specimens, six animals had natural death and were members of the research collection of the Laboratory of Anatomy, and four were killed after anaesthesia. Stained bi-centrifugated-Cis-I-4 latex was injected in arterial vessels responsible for penis vascularization throughout the abdominal portion of aorta. The samples were fixed in 10% formaldehyde solution and arteries were dissected. The penile artery is originated as a branch of internal pudendal artery. At the level of ischiatic arch, the penile artery project two branches, the penile dorsal and the deep arteries; those arteries irrigates the penile dorsal surface and the corpus cavernosum penis. The penile dorsal arteries have an independent course up to the glans penis. Based on the conditions of this work a remarkable similarity regarding the distribution of vessels destined to the agouti penis when compared to other domestic, wild and lagomorph rodents as rabbits.

Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma. Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients. On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient. We conclude that embolization-particularly n-butyl cyanoacrylate embolization-is technically feasible in patients with penetrating peripheral arterial trauma.

Case Report: Delayed Hemorrhage from an Accessory Internal Pudendal Artery Pseudoaneurysm after Robotic Radical Prostatectomy: Successful Management with CT Angiography and Embolization

We present the first report of a pseudoaneurysm of an accessory internal pudendal artery after transperitoneal robotic radical prostatectomy. The vesicourethral anastomosis was performed using two continuous 3-0 Monocryl sutures tied at the six o'clock position. As the anastomotic suture was placed at 11 o'clock, lateral to the dorsal venous complex, there was a small amount of pulsatile bleeding that ceased when the suture was completed and tied. The lesion presented as hematuria beginning on the fourth day. On the 14(th) day, the pseudoaneurysm was diagnosed by CT angiography and treated by embolization with eight 3-mm/30-mm micro coils after superselective catheterization. There were no complications or further hematuria.

Patient Presentation and Management of Labial Ulceration Following Uterine Artery Embolization

Uterine artery embolization is a safe and effective procedure for the treatment of symptomatic uterine fibroids. Nontarget embolization of adjacent internal iliac artery branches is a reported complication of uterine artery embolization. The following report describes the presentation and management of ulcerations of the labium minora due to nontarget embolization of the internal pudendal artery.

Age‐dependent changes in the pigeon bursa of Fabricius vasculature: a comparative study using light microscopy and scanning electron microscopy of vessel casts

The present study was carried out to analyse the vascularization of the pigeon bursa cloacalis of Fabricius and to determine whether it undergoes age-dependent changes during its functionally most important growth period after hatching of the pigeon. Morphological assessment of vascular corrosion casts, studied qualitatively and quantitatively, was applied for the first time to investigate the vascularization of the pigeon pigeon bursa of Fabricius. This also allowed us to analyse the microvasculature and morphological aspects of the vessel interrelationships as occurring in the natural state. The casts were compared with histological sections stained by haematoxylin-eosin and by binding of the lectin e-PHA (Phaseolus vulgaris, erythroagglutinin) to blood vessels. The vascular architecture of the bursa of Fabricius of the pigeon revealed that the organ is irrigated via two pathways, first through the terminal capillary system of lymphoid follicles arising from the internal pudendal artery, and secondly through arteries originating from the cloacal vasculature of the collum of the organ supplying the periluminal capillary system of the pigeon bursa of Fabricius. Both systems are drained by a venous system which is collateral to the system of the internal pudendal artery and clearly functions as a direct link between the lumen and vasculature of the cloaca or gut, respectively, and the bursa fabricii. This could allow the lymphocytes to be confronted with antigens from the contents of the gut, and their subsequent transport into the secondary lymphoid organs of the organism. Our results demonstrate that the blood vessels, as major and supplying part of the lymphoid system of the bursa Fabricii, clearly reflect three different phases of development: the evolution phase from about day 20 until day 50 post-hatching, the mature phase from days 50 to 90, and the involution phase after day 90. During the evolution phase the density of the vessel system rapidly increases, while in the mature phase the vascular architecture is maintained. The involution phase is dominated by vascular degeneration combined with shrinkage of the whole organ. Therefore, the morphology of the vasculature distinctly reflects the functional status of this primary lymphoid organ during its lifespan.

Post traumatic prepubertal high-flow priapism: a rare occurrence

High-flow or arterial priapism is an uncommon condition resulting from perineal or penile trauma. The classical features are a painless erection of the cavernous bodies while the corpus spongiosum stays flaccid. This case highlights a 11-year-old boy who presented with painless semi rigid erection of 3 days duration following a blunt skateboard injury to his perineum. Following failed conservative treatment, the patient underwent bilateral internal pudendal angiography with localization and embolization. Follow up in 1 month showed patient to have normal nocturnal and reflexogenic erections. Medical and surgical treatments for high-flow priapism have been described in literature with varying degree of success and complications. The current accepted standard of care is pelvic angiography and super-selective embolization of internal pudendal artery.

Superselective arterial embolization for patients with high-flow priapism: results of follow-up for five or more years

To retrospectively evaluate the long-term results of transcatheter arterial embolization for high-flow priapism. The study comprised six patients with high-flow priapism treated by superselective embolization of the internal pudendal arteries at our institution. The cause of priapism was traumatic in five patients and idiopathic in one. Follow-up was > or = 5 years in all cases. A total of nine embolizations were performed in the six patients. Embolization was performed once in three patients, while repeated embolizations were performed in the remaining three. Eleven arteries were altogether treated. Embolic materials used were gelatin sponge in nine arteries, gelatin sponge and microcoils in one, and microcoils alone in one. Embolization of the internal pudendal arteries on both sides in one single session was performed in one patient. In one patient, complete occlusion of the pseudoaneurysm was not achieved. However, restoration of erectile function and detumescence were noted during follow-up. Complications during the procedure were not registered. At follow-up > or = 5 years after successful embolization, all six patients experienced detumescence as well as normal erectile function. Superselective embolization of the internal pudendal artery is the procedure of choice for treatment of high-flow priapism.

Embolization for massive urethral hemorrhage

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.

Anomalous Branch of Internal Pudendal Artery

La arteria isquiatica se describe clasicamente como una rama de la arteria glutea inferior, es un vaso largo y delgado que se relaciona con el nervio isquiatico. En una diseccion se observo que esta arteria surge de la arteria pudenda interna con un calibre mas grande que lo descrito en la literatura. El conocimiento de variaciones anatomicas es importante para los cirujanos, radiologos y anatomistas

Massive Rectal Hemorrhage from the Middle Hemorrhoidal Artery after Blunt Perineal Trauma Without Pelvic Fracture.

Severe pelvic hemorrhage after blunt trauma without bony fracture has been reported occasionally, and clinical presentation as a delayed massive rectal bleeding is very rare. The case of an 86-year-old woman with massive rectal bleeding 12 h after mild blunt perineal trauma is presented. Physical examination revealed an extensive perineal hematoma and a 2-cm laceration in the posterior rectal wall. Pelvic CT scan revealed a large mesorectal hematoma causing extrinsic compression of the rectal lumen. No bony fracture was observed. Selective arteriography was then performed showing hemorrhage resulting from the right middle hemorrhoidal artery, branch of the internal pudendal artery. Transcatheter embolization of coils successfully controlled the bleeding. However, the patient developed a respiratory distress syndrome and renal failure with no response to the treatment and she died 3 days later. This report is unique not only for the unusual association of pelvic hemorrhage and rectal injury after blunt trauma without pelvic fracture but also because of the clinical presentation as a massive rectal bleeding. Undoubtedly, the delayed diagnosis and treatment, 12 h after the trauma, contributed to the fatal outcome.

Distribution of the internal pudendal artery in male and female llama ( Lama glama)

The aim of this research has been to describe the internal pudendal artery distribution in male and female llama and to compare it with that of other domestic animals including the one-humped camel (Camelus dromedarius). The arterial system was perfused with a solution of 14% coloured plaster and preserved in a solution of a 10% formalin, 3% carbolic acid and 3% glycerine. The systematic dissection was made using traditional working techniques and standard instruments. The internal pudendal artery is the ventral terminal branch of the internal iliac artery at the level of the third sacral vertebra. The main supply of the pelvic organs comes from the prostatic or vaginal arteries; notwithstanding these arteries arise from the internal pudendal artery, showing an important difference between ruminants and pig (long iliac type). Similarities between the distribution of the internal pudendal artery of the llama and those obtained in the camel provide strong evidence of a common phylogenetic origin.