Male Pelvis Research Articles

Ultrasound Emergencies of the Male Pelvis

Male pelvic emergencies are uncommon, and symptoms typically include scrotal pain, scrotal enlargement, or a palpable scrotal mass or all of these. Ultrasound is often the first-line modality for evaluation of male pelvic emergencies, which may be stratified into vascular, infectious, or traumatic causes. Entities such as testicular torsion, Fournier gangrene, and testicular dislocation are surgical emergencies and should not be missed or misdiagnosed, as this may cause a significant delay in urgently necessary treatment. Radiologists need to be familiar with the role of imaging as well as the key characteristic imaging findings of these injuries to direct the appropriate management.

Combined laparoscopic and transanal total mesorectal excision for rectal cancer: Initial experience and early results.

INTRODUCTION:Incomplete specimens resulting in residual mesorectum in the patient and an increased risk of local recurrence remains a problem. We have introduced transanal-total mesorectal excision (Ta-TME) in our department to potentially overcome this problem due to more direct access to the lower pelvis in patients undergoing TME for rectal cancer and this article presents our initial experience with the new procedure.MATERIALS AND METHODS:Patients with a T1-T3 mid or low rectal cancer eligible for TME or intersphincteric abdominoperineal excision were selected for a combined transanal and transabdominal laparoscopic resection. The primary aim of the study was to evaluate the feasibility and efficacy of the method with a special focus on the quality of the specimen.RESULTS:During a 9-month period, 11 patients were operated with this technique. All procedures resulted in complete or nearly complete specimen. We did, however, find the procedure technically demanding and experienced several complications with three anastomotic leaks (all with preserved intestinal continuity) and a urethral lesion.CONCLUSION:Ta-TME is feasible and might be the answer to obtaining good quality specimens and overcome some of the technical difficulties that can be encountered in the obese narrow male pelvis. The procedure however is technically demanding.

Editorial Comment

The accompanying article shows that the new method of prostate biopsy is gaining traction. Most studies evaluating prostate magnetic resonance imaging (MRI) have been performed at a handful of academic institutions, where 1 or 2 experienced radiologists supervise and interpret the imaging, and biopsy is MRI guided. 1 Filson C.P. Natarajan S. Margolis D.J.A. et al. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies. Cancer. 2016; 122: 884-892 Crossref PubMed Scopus (304) Google Scholar , 2 Siddiqui M.M. Rais-Bahrami S. Turkbey B. et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2016; 1210: 390-397 Google Scholar , 3 Barentsz J.O. Engelbrecht M.R.W. Witjes J.A.M. De La Rosette J.J.M.C.H. Van Der Graaf M. MR imaging of the male pelvis. Eur Radiol. 1999; 9: 1722-1736 Crossref PubMed Scopus (62) Google Scholar , 4 Moore C.M. Robertson N.L. Arsanious N. et al. Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol. 2013; 63: 125-140 Abstract Full Text Full Text PDF PubMed Scopus (441) Google Scholar The academic institutions have developed specialized resources in urology, radiology, and pathology to make the new approach possible. Thus, most information currently in the medical literature may be difficult to apply in settings where such resources are not available.

A cadaveric study of the testicular artery and its clinical significance.

BackgroundKnowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy.ObjectivesThe present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins.MethodsThis study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured.ResultsTesticular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication.ConclusionThis study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.

Deformable image registration for adaptive radiotherapy with guaranteed local rigidity constraints.

BackgroundDeformable image registration (DIR) is a key component in many radiotherapy applications. However, often resulting deformations are not satisfying, since varying deformation properties of different anatomical regions are not considered. To improve the plausibility of DIR in adaptive radiotherapy in the male pelvic area, this work integrates a local rigidity deformation model into a DIR algorithm.MethodsA DIR framework is extended by constraints, enforcing locally rigid deformation behavior for arbitrary delineated structures. The approach restricts those structures to rigid deformations, while surrounding tissue is still allowed to deform elastically. The algorithm is tested on ten CT/CBCT male pelvis datasets with active rigidity constraints on bones and prostate and compared to the Varian SmartAdapt deformable registration (VSA) on delineations of bladder, prostate and bones.ResultsThe approach with no rigid structures (REG0) obtains an average dice similarity coefficient (DSC) of 0.87 ± 0.06 and a Hausdorff-Distance (HD) of 8.74 ± 5.95 mm. The new approach with rigid bones (REG1) yields a DSC of 0.87 ± 0.07, HD 8.91 ± 5.89 mm. Rigid deformation of bones and prostate (REG2) obtains 0.87 ± 0.06, HD 8.73 ± 6.01 mm, while VSA yields a DSC of 0.86 ± 0.07, HD 10.22 ± 6.62 mm. No deformation grid foldings are observed for REG0 and REG1 in 7 of 10 cases; for REG2 in 8 of 10 cases, with no grid foldings in prostate, an average of 0.08 % in bladder (REG2: no foldings) and 0.01 % inside the body contour. VSA exhibits grid foldings in each case, with an average percentage of 1.81 % for prostate, 1.74 % for bladder and 0.12 % for the body contour. While REG1 and REG2 keep bones rigid, elastic bone deformations are observed with REG0 and VSA. An average runtime of 26.2 s was achieved with REG1; 31.1 s with REG2, compared to 10.5 s with REG0 and 10.7 s with VMS.ConclusionsWith accuracy in the range of VSA, the new approach with constraints delivers physically more plausible deformations in the pelvic area with guaranteed rigidity of arbitrary structures. Although the algorithm uses an advanced deformation model, clinically feasible runtimes are achieved.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0697-4) contains supplementary material, which is available to authorized users.

Automatic multiorgan segmentation in CT images of the male pelvis using region-specific hierarchical appearance cluster models.

Accurate segmentation of pelvic organs in CT images is of great importance in external beam radiotherapy for prostate cancer. The aim of this studying is to develop a novel method for automatic, multiorgan segmentation of the male pelvis. The authors' segmentation method consists of several stages. First, a pretreatment includes parameterization, principal component analysis (PCA), and an established process of region-specific hierarchical appearance cluster (RSHAC) model which was executed on the training dataset. After the preprocessing, online automatic segmentation of new CT images is achieved by combining the RSHAC model with the PCA-based point distribution model. Fifty pelvic CT from eight prostate cancer patients were used as the training dataset. From another 20 prostate cancer patients, 210 CT images were used for independent validation of the segmentation method. In the training dataset, 15 PCA modes were needed to represent 95% of shape variations of pelvic organs. When tested on the validation dataset, the authors' segmentation method had an average Dice similarity coefficient and mean absolute distance of 0.751 and 0.371 cm, 0.783 and 0.303 cm, 0.573 and 0.604 cm for prostate, bladder, and rectum, respectively. The automated segmentation process took on average 5 min on a personal computer equipped with Core 2 Duo CPU of 2.8 GHz and 8 GB RAM. The authors have developed an efficient and reliable method for automatic segmentation of multiple organs in the male pelvis. This method should be useful for treatment planning and adaptive replanning for prostate cancer radiotherapy. With this method, the physicist can improve the work efficiency and stability.

Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy.

Development of prostatic arterial embolization (PAE) to treat benign prostatic hyperplasia (BPH) has raised interest in the variations of the prostatic arteries (PA). The aim of this study is to identify these vascular variations, to compare them with previous data, and to propose a simple classification. Ten adult male pelvis sides from embalmed cadavers were dissected, ages 69 to 92 years, and 10 PA were examined. In a retrospective analysis of 34 DSA pelvic angiographies on 28 patients aged 50 to 90 years, 48 PA were identified. A total of 58 PA were therefore analyzed. Six types are defined. Type I: PA originates from the anterior division (AD) of the internal iliac artery (IIA), 20.7%; Type II: PA emerges from the obturator artery (OA), 5.2%; type III: PA arises from the gluteal-pudendal trunk (GPT), 27.5%; Type IV: PA originates from the internal pudendal artery (IPA), 29.3%; Type V: PA comes from the middle rectal artery (MRA), 15.5%. Other origins, not observed in our sample but described in the literature, were amalgamated under Type VI. The AD/GPT/IPA stem is the main source of the PA. Analysis of the definitions of IIA branches and the associated terminology is necessary for interpreting the results reported by several authors on different samples, but in general the results fit the meta-analysis well. A new, simple, and complete classification for vascular variations of the PA is proposed. Clin. Anat. 30:71-80, 2017. © 2016 Wiley Periodicals, Inc.

Botulinum Toxin A: Evolving Treatment Strategies for the Chronic Pelvic Pain Patient

Chronic pelvic pain syndrome (CPPS) is defined as pain perceived within the structures of the male or female pelvis of at least 6-month duration. The management of CPPS in both men and women poses a challenge to both the clinician and the patient. Botulinum toxin type A (BoNT-A) is known to block the release of neurotransmitters at the neuromuscular junction but also appears to have anti-nociceptive and anti-inflammatory effects. BoNT-A has been used for over two decades to treat conditions associated with pathological muscle hyperactivity. There is emerging evidence that BoNT-A may play a role in treating CPPS when alternate treatments and more conservative measures have been ineffective. Moving forward, well-designed clinical trials are needed to further investigate the utility of BoNT-A use in the treatment of CPPS.

Influence of fractional anisotropy thresholds on diffusion tensor imaging tractography of the periprostatic neurovascular bundle and selected pelvic tissues: do visualized tracts really represent nerves?

Background Diffusion tensor imaging (DTI) tractography has recently been shown to successfully visualize periprostatic tracts allegedly representing the neurovascular bundle. Purpose To examine the impact of different fractional anisotropy (FA) thresholds on the results of DTI tractography in the male pelvis as well as to evaluate the resulting specificity for nerve tracts. Material and Methods Ten healthy male volunteers were examined at 3 Tesla. DTI tractography was performed based on seed points placed circularly around the prostate, in the rectoprostatic angle, the peripheral zone of the prostate, the sciatic nerve, and in addition the urinary bladder using FA thresholds of 0.20, 0.05, and 0.01. DTI tract number and DTI tract length measured with different FA thresholds were compared. ANOVA with repeated measures was used for statistics. Results DTI tract number and tract length were significantly dependent on FA thresholds. While a FA threshold of 0.20 visualized the typical distribution of DTI tracts in the sciatic nerve, a FA threshold of ≤0.05 was necessary to yield results visually mimicking the distribution of nerve tracts in the NVB. However, with such low FA thresholds even in the filled urinary bladder DTI tracts could be visualized. With FA thresholds of 0.20, the number and length of periprostatic DTI tracts did not differ from those measured within the prostate. Conclusion DTI tractography can be used to visualize DTI tracts periprostatically. However, one may doubt that these DTI tracts represent nerve tracts and that the periprostatic neurovascular bundle can be evaluated in a meaningful way with the current methods available.

Gonad dose in AP pelvis radiography: Impact of anode heel orientation

PurposeFor antero posterior (AP) pelvis radiographic examination, determine the impact of anode heel orientation on female/male gonad dose. MethodsHigh sensitivity thermo-luminescent dosimeters (TLDs) were used with an ATOM dosimetry phantom; the phantom was positioned for AP pelvis. TLDs were placed into the testes and ovaries. Radiation dose received by these organs was measured with the feet toward anode and feet toward the cathode. kVp, mAs and SID were manipulated to generate a range of exposures. A dose profile was also generated using Unfors Mult-O-Meter 401 along the long axis of the phantom. ResultsA decrease in dose from the central ray toward the anode was noted, with a marked increase toward the cathode. A significant reduction in dose was received by the testes with feet towards the anode compared with feet towards cathode (P˂0.001). No difference was seen for ovarian dose (P˃0.05). kVp, mAs and SID all have an effect on male and female gonad dose. ConclusionFor male pelvis imaging, placing feet towards the anode can be used as a simple dose reduction method.

TH-CD-202-07: A Methodology for Generating Numerical Phantoms for Radiation Therapy Using Geometric Attribute Distribution Models

Purpose: A persistent challenge for the quality assessment of radiation therapy treatments (e.g. contouring accuracy) is the absence of the known, ground truth for patient data. Moreover, assessment results are often patient-dependent. Computer simulation studies utilizing numerical phantoms can be performed for quality assessment with a known ground truth. However, previously reported numerical phantoms do not include the statistical properties of inter-patient variations, as their models are based on only one patient. In addition, these models do not incorporate tumor data. In this study, a methodology was developed for generating numerical phantoms which encapsulate the statistical variations of patients within radiation therapy, including tumors. Methods: Based on previous work in contouring assessment, geometric attribute distribution (GAD) models were employed to model both the deterministic and stochastic properties of individual organs via principle component analysis. Using pre-existing radiation therapy contour data, the GAD models are trained to model the shape and centroid distributions of each organ. Then, organs with different shapes and positions can be generated by assigning statistically sound weights to the GAD model parameters. Organ contour data from 20 retrospective prostate patient cases were manually extracted and utilized to train the GAD models. As a demonstration, computer-simulated CT images of generated numerical phantoms were calculated and assessed subjectively and objectively for realism. Results: A cohort of numerical phantoms of the male human pelvis was generated. CT images were deemed realistic both subjectively and objectively in terms of image noise power spectrum. Conclusion: A methodology has been developed to generate realistic numerical anthropomorphic phantoms using pre-existing radiation therapy data. The GAD models guarantee that generated organs span the statistical distribution of observed radiation therapy patients, according to the training dataset. The methodology enables radiation therapy treatment assessment with multi-modality imaging and a known ground truth, and without patient-dependent bias.

SU‐F‐J‐97: A Joint Registration and Segmentation Approach for Large Bladder Deformations in Adaptive Radiotherapy

Purpose:To improve results of deformable image registration (DIR) in adaptive radiotherapy for large bladder deformations in CT/CBCT pelvis imaging.Methods:A variational multi‐modal DIR algorithm is incorporated in a joint iterative scheme, alternating between segmentation based bladder matching and registration. Using an initial DIR to propagate the bladder contour to the CBCT, in a segmentation step the contour is improved by discrete image gradient sampling along all surface normals and adapting the delineation to match the location of each maximum (with a search range of +−5/2mm at the superior/inferior bladder side and step size of 0.5mm). An additional graph‐cut based constraint limits the maximum difference between neighboring points. This improved contour is utilized in a subsequent DIR with a surface matching constraint. By calculating an euclidean distance map of the improved contour surface, the new constraint enforces the DIR to map each point of the original contour onto the improved contour. The resulting deformation is then used as a starting guess to compute a deformation update, which can again be used for the next segmentation step. The result is a dense deformation, able to capture much larger bladder deformations. The new method is evaluated on ten CT/CBCT male pelvis datasets, calculating Dice similarity coefficients (DSC) between the final propagated bladder contour and a manually delineated gold standard on the CBCT image.Results:Over all ten cases, an average DSC of 0.93±0.03 is achieved on the bladder. Compared with the initial DIR (0.88±0.05), the DSC is equal (2 cases) or improved (8 cases). Additionally, DSC accuracy of femoral bones (0.94±0.02) was not affected.Conclusion:The new approach shows that using the presented alternating segmentation/registration approach, the results of bladder DIR in the pelvis region can be greatly improved, especially for cases with large variations in bladder volume.Fraunhofer MEVIS received funding from a research grant by Varian Medical Systems.

Clinical anatomic study of the lag screw guide device for the acetabulum anterior column

Objective To measure anatomical parameters of the guide device for antegrade lag screw fixation for the fractures in the anterior column of acetabulum. Methods 56 cases (29 female and 27 male) pelvis CT scans were collected to this clinical anatomic study. After virtual antegrade lag screw was successfully implanted in the anterior column of acetabulum, the screw entry point and entry angle of inclination were separately measured and statistically analyzed. These parameters were then used to design the guide device and be verified on 19 pelvis specimens. Results The average distance from the entry point to apex of greater sciatic notch was 25.11±5.91 mm in female and 17.51±2.94 mm in male, while the distance from the entry point to ischial spine was 60.11±5.37 mm in female and 52.64±6.30 mm in male. The average anteversion angle of screw was 69.72°± 5.66° in female and 78.14°± 3.50° in male, while the extraversion angulation was 75.55°± 13.66° in female and 62.18°±8.60° in male. The maximum diameter of the lag screw was 6.18±1.73 mm in female and 6.43±2.16 mm in male. The success rate of the screw implantation assisted by the guide device was 84.21% (16/19); while the rate decreases to 31.58% (6/19) in traditional method. Conclusion Guide device for antegrade lag screw could improve the success rate and accuracy of the screw implantation in the anterior column of acetabulum and reduce the surgery risk, as well as minimize operative trauma. Key words: Acetabulum; Fractures, bone; Internal fixators

Developmental evidence for obstetric adaptation of the human female pelvis

The bony pelvis of adult humans exhibits marked sexual dimorphism, which is traditionally interpreted in the framework of the "obstetrical dilemma" hypothesis: Giving birth to large-brained/large-bodied babies requires a wide pelvis, whereas efficient bipedal locomotion requires a narrow pelvis. This hypothesis has been challenged recently on biomechanical, metabolic, and biocultural grounds, so that it remains unclear which factors are responsible for sex-specific differences in adult pelvic morphology. Here we address this issue from a developmental perspective. We use methods of biomedical imaging and geometric morphometrics to analyze changes in pelvic morphology from late fetal stages to adulthood in a known-age/known-sex forensic/clinical sample. Results show that, until puberty, female and male pelves exhibit only moderate sexual dimorphism and follow largely similar developmental trajectories. With the onset of puberty, however, the female trajectory diverges substantially from the common course, resulting in rapid expansion of obstetrically relevant pelvic dimensions up to the age of 25-30 y. From 40 y onward females resume a mode of pelvic development similar to males, resulting in significant reduction of obstetric dimensions. This complex developmental trajectory is likely linked to the pubertal rise and premenopausal fall of estradiol levels and results in the obstetrically most adequate pelvic morphology during the time of maximum female fertility. The evidence that hormones mediate female pelvic development and morphology supports the view that solutions of the obstetrical dilemma depend not only on selection and adaptation but also on developmental plasticity as a response to ecological/nutritional factors during a female's lifetime.

Combining all forces: abdominoperineal resection in an obese male.

In patients with rectal cancer, pelvic dissection is challenging. A complete total mesorectal excision (TME) is particularly difficult in a narrow and long pelvis often encountered in males. This difficulty is compounded in the obese. In addition to the open approach being morbid, laparoscopy has often proven difficult secondary to rigid instruments along with a steep learning curve. Robot assistance offers an advantage, however limitations are observed in abdominal colon dissection outside of the pelvis. As these individual modalities have their disadvantages, they each can contribute unique aspects in a combined or a hybrid approach to rectal tumors. Therefore, a multi-modal, combined approach, involving hand assist, laparoscopic, and robotic assistance, to a 5-cm tumor at the anal verge was applied to an abdominoperineal resection in an obese, male patient. An obese 58-year-old male, BMI of 36 kg/m2, with a 5-cm anal canal squamous cell carcinoma which recurred after Nigro protocol treatment, underwent a multi-modal abdominoperineal resection. The approach to recurrent anal cancer is as that for rectal cancer. Hence, a hand port was placed to assist in colon mobilization, visceral mesenteric dissection, and to facilitate the laparoscopic division of the inferior mesenteric artery (IMA) at its origin. The robot was used for deep pelvic dissection and TME. The levators were divided in the perineal phase. A complete mesorectal excision was achieved and a cylindrical specimen was extracted. An abdominoperineal resection with a multi-modal approach (hand assist, laparoscopic, and robotic) is safe and effective in resection of low rectal cancers especially in the narrow, obese, and male pelvis.

Penile intracavernosal pillars: lessons from anatomy and potential implications for penile prosthesis placement.

The objective of this study was to anatomically describe the relationship of penile intracavernosal pillars to penile surgery, specifically corporal dilation during penile prosthesis placement. Corpora cavernosa from four embalmed male cadavers were dissected and subjected to probe dilation. Corpora were cross-sectioned and examined for the gross presence and location of pillars and dilated spaces. Infrapubic penile prosthesis insertion was performed on one fresh-frozen cadaveric male pelvis, followed by cross-sectioning. A single patient had intracavernosal pillars examined intraoperatively during Peyronie's plaque excision and penile prosthesis insertion. Intracavernosal pillars were identified in all cadavers and one surgical patient, passing obliquely from the dorsolateral tunica albuginea across the sinusoidal space to the ventral intercorporal septum. This delineated each corpus into two potential compartments for dilation: dorsomedial and ventrolateral. Dorsal dilation seated instruments and prosthetics satisfactorily in the dorsal mid glans and provided additional tissue coverage over weak ventral areas of the tunica albuginea, while ventrolateral dilation appeared to result in ventral seating and susceptibility to perforation. Intracavernosal pillars are an important anatomic consideration during penile prosthesis placement. Dorsal dilation appears to result in improved distal seating of cylinder tips, which may be protective against tip malposition, perforation or subsequent erosion.

PD49-08 TREATMENT OF COMPLICATIONS AFTER PROACT® IMPLANTATION IN MEN WITH STRESS URINARY INCONTINENCE FOLLOWING RADICAL PROSTATECTOMY: A RETROSPECTIVE ANALYSIS OF 252 IMPLANTS IN A SINGLE CENTRE

study is to examine the feasibility of utilizing a computational model of the male pelvis to characterize the urethral mobility in men under increased intra-abdominal pressure. METHODS: A comprehensive subject specific pelvic model was developed from high-resolution images of a healthy male with an intact prostate for biomechanical analysis with the finite element method. The Valsalva maneuver was simulated by applying a pressure to the intra-abdominal space. Intra-vesical pressure, urethra and bladder neck displacement were monitored during the simulation to quantify urethral mobility. RESULTS: Our simulation produced results similar to those seen in dynamic magnetic resonance images (MRI). The bladder and prostate deformed posteriorly (Figure 1). At an intra-vesical pressure (IVP) of 100cmH2O. This change in pelvic configuration resulted in a posterior deformation of the bladder neck, proximal urethra, and distal urethra of 2.5mm, 2.4mm, and 0.7mm respectively (Figure 2). The urethra underwent a 6.4 degree caudal rotation. CONCLUSIONS: Computational modeling and biomechanical analysis can be a valuable tool in assessing the dynamic mechanics of the pelvic floor under pressure events. With post-surgery MRI data, patient-specific post-prostatectomy models will be developed to evaluate the effect of the prostatectomy on urethral mobility and/or the pressure that the urethra is compressed against the hammock-like supportive layer.

Does hemipelvis structure and position influence acetabulum orientation?

BackgroundAlthough acetabulum orientation is well established anatomically and radiographically, its relation to the innominate bone has rarely been addressed. If explored, it could open the discussion on patomechanisms of such complex disorders as femoroacetabular impingement (FAI). We therefore evaluated the influence of pelvic bone position and structure on acetabular spatial orientation. We describe this relation and its clinical implications.MethodsThis retrospective study was based on computed tomography scanning of three-dimensional models of 31 consecutive male pelvises (62 acetabulums). All measurements were based on CT spatial reconstruction with the use of highly specialized software (Rhinoceros). Relations between acetabular orientation (inclination, tilt, anteversion angles) and pelvic structure were evaluated. The following parameters were evaluated to assess the pelvic structure: iliac opening angle, iliac tilt angle, interspinous distance (ISD), intertuberous distance (ITD), height of the pelvis (HP), and the ISD/ITD/HP ratio. The linear and nonlinear dependence of the acetabular angles and hemipelvic measurements were examined with Pearson’s product − moment correlation and Spearman’s rank correlation coefficient. Correlations different from 0 with p < 0.05 were considered statistically significant.ResultsComparison of the axis position with pelvis structure with orientation in the horizontal plane revealed a significant positive correlation between the acetabular anteversion angle and the iliac opening angle (p = 0.041 and 0.008, respectively). In the frontal plane, there was a positive correlation between the acetabular inclination angle and the iliac tilt angle (p = 0.025 and 0.014, respectively) and the acetabular inclination angle and the ISD/ITD/HP ratio (both p = 0.048).ConclusionsThere is a significant correlation of the hemipelvic structure and acetabular orientation under anatomic conditions, especially in the frontal and horizontal planes. In the anteroposterior view, the more tilted-down innominate bone causes a more caudally oriented acetabulum axis, whereas in the horizontal view this relation is reversed. This study may serve as a basis for the discussion on the role of the pelvis in common disorders of the hip.

Sexual Dimorphism in Human Sacrum in Maharshtra Population

Identification of sex in human skeletal remains is a big challenge to the anatomists, forensic experts, and anthropologists. Human pelvis is one of the most important skeletal element in view of sex identification. The differences in male and female pelvis are attributed to the functional need at the time of parturition.

Varicose veins in the male small pelvis (a review of literature)

In this study, an analysis data on the etiology, pathogenesis, diagnosis and treatment of pelvic varices in men. With the solution the varicose pelvic men face different specialists: surgeons, urologists, andrology, reproduction. The pelvic varices unlike women in men is a little-studied disease. Insufficient knowledge of the disease in men and its effect on the body along with the prevalence necessitates the definition of the field of knowledge, which is aiming to be involved in this issue.