Pelvic Sides Research Articles

Anatomia Radiológica da Disfunção Erétil Arteriogénica: Uma Abordagem Sistematizada

Erectile Dysfunction is a highly prevalent disease and there is growing interest in its endovascular treatment. Due to the complexity of the male pelvic arterial system, thorough anatomical knowledge is paramount. We evaluated the applicability of the Yamaki classification with Computerized Tomography Angiography and Digital Subtraction Angiography in the evaluation of patients with arteriogenic Erectile Dysfunction, illustrating the arterial lesions that can cause Erectile Dysfunction. Single-center retrospective analysis of the Computerized Tomography Angiography and Digital Subtraction Angiography imaging findings in 21 male patients with suspected arteriogenic Erectile Dysfunction that underwent selective pelvic arterial embolization. Assessment of erectile function was achieved using the IIEF-5. The branching patterns of the Internal Iliac Artery were classified according to the Yamaki classification. The diagnosis of arteriogenic Erectile Dysfunction was based on the presence of atherosclerotic lesions (stenoses and/or occlusions) of the Internal Iliac Artery or the Internal Pudendal Arteries. The mean patient age was 67.2 years; with a mean IIEF of 10.6 points. Computerized Tomography Angiography and Digital Subtraction Angiography findings allowed classification of all the 42 pelvic sides according to the Yamaki classification. Twenty-four pelvic sides were classified as Group A (57%), 9 as Group B (21.5%) and 9 as Group C (21.5%). The Digital Subtraction Angiography detected 19 abnormal Internal Pudendal Arteries (with atherosclerotic lesions) (45%). The Computerized Tomography Angiography detected 24 abnormal Internal Pudendal Arteries (57%). Computerized Tomography Angiography and Digital Subtraction Angiography findings of arteriogenic Erectile Dysfunction include stenotic and occlusive lesions of the Internal Iliac Artery and Internal Pudendal Artery. The Yamaki classification is radiologically reproducible and allows easy recognition of the Internal Pudendal Artery in patients with arteriogenic Erectile Dysfunction.

Cameriere’s approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics

According to a modified method originally developed by Cameriere et al. (Int J Legal Med 120:143-146, 2006; J Forensic Sci 52:1151-1155, 2007; Forensic Sci Int 174:59-62, 2008; Forensic Sci Int 174:178-181, 2008; Forensic Sci Int 193:128.e1-128.e6, 2009), the suitability of the iliac crest apophysis (ICA) for the purpose of forensic age estimation in living individuals was investigated by means of area measurements in 643 pelvic radiographs of patients aged between 10 and 30years. The area of the ossification centre(s) of the iliac crest and the area of the iliac wing (IW) were determined by manual segmentation. In 116 cases, area measurements were possible. ICA/IW ratios were calculated and used for regression analyses, yielding different regression equations. Depending on sex, pelvic side and ratio considered, R (2) ranged between 0.20 and 0.38 and the standard error of the estimate, between 1.91 and 2.00years. No statistical significant differences were found between the right and the left pelvic sides. In conclusion, this method is potentially applicable for forensic age estimation in living individuals. However, further studies under more standardised conditions and with higher case numbers are needed in order to decide whether the iliac crest apophysis might become suitable for routine age diagnostics.

Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography

This work aimed to study the prevalence and radiologic anatomy of the middle rectal artery (MRA) using computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The retrospective study (October 2010-February 2012) focused in 167 male patients with prostate enlargement (mean age 64.7years, range 47-81years) who underwent selective pelvic arterial embolization for the relief of lower urinary tract symptoms. All patients underwent CTA previously to DSA to evaluate the vascular anatomy of the pelvis and to plan the treatment. MRAs were identified and classified according to their origin, trajectory, termination and relationship with surrounding arteries. We found MRAs in 60 (35.9%) patients (23.9% of pelvic sides, n=80) and of those, 20 (12%) had bilateral MRAs; 24 MRAs (30%) were independent of neighbouring arteries and 56 MRAs (70%) had common origins with prostatic arteries (prostato-rectal trunk). The most frequent MRA origin was the internal pudendal artery (60%, n=48), followed by the inferior gluteal artery (21.3%, n=17) and common gluteal-pudendal trunk (16.2%, n=13). In 2 patients the MRA originated from the obturator artery (2.5%). Anastomoses to the superior rectal and inferior mesenteric arteries were found in 87.5% of cases (n=70). We concluded that MRAs are anatomical variants present in less than half of male patients; have variable origins and frequently share common origins with prostatic arteries. Their correct identification is likely to contribute to improve interventional radiology procedures and prostatic or rectal surgeries.

Radiological Anatomy of Prostatic Arteries

One of the most challenging aspects of prostatic arterial embolization for patients with lower urinary tract symptoms and prostate enlargement or benign prostatic hyperplasia is identifying the prostatic arteries (PAs). With preprocedural computed tomography angiography it is possible to plan treatment and exclude patients when arterial anatomy is not suited, or when extensive atherosclerotic changes may affect technical success. There is an excellent correlation between the computed tomography angiography and digital subtraction angiography findings, enabling correct depiction of the male pelvic arterial anatomy (internal iliac branching patterns, relevant variants as accessory pudendal arteries, and PA anatomy). The prostate has a dual vascular arterial supply: a cranial or vesico-PA (named anterior-lateral prostatic pedicle) and a caudal PA (named posterior-lateral prostatic pedicle). These 2 prostatic pedicles may arise from the same artery in patients with only 1 PA (found in 60% of pelvic sides), or may arise independently in patients with 2 independent PAs (found in 40% of pelvic sides). The anterior-lateral prostatic pedicle vascularizes most of the central gland and benign prostatic hyperplasia nodules, frequently arises from the superior vesical artery in patients with 2 independent PAs, and is the preferred artery to embolize. The posterior-lateral prostatic pedicle has an inferior or distal origin, vascularizes most of the peripheral and caudal gland, and may have a close relationship with rectal or anal branches. In up to 60% of cases considerable anastomoses may be seen between the prostatic branches and surrounding arteries that should be taken into account when planning embolization. PAs lack pathognomonic digital subtraction angiography features; thus correct anatomical identification of the male pelvic and PAs is necessary to avoid untargeted ischemia to the bladder, rectum, anus, or corpus cavernosum.

Prostatic Arterial Supply: Anatomic and Imaging Findings Relevant for Selective Arterial Embolization

PurposeTo describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH). Materials and MethodsIn a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries. ResultsA total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal–pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression. ConclusionsPAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.

Impact of selective surgical pelvic autonomic nerve damage on the evoked neuromonitoring signal of the internal anal sphincter

Introduction: A novel intraoperative neuromonitoring (IONM) method based on electric stimulation of pelvic autonomic nerves under electromyography of the internal anal sphincter (IAS) has been recently introduced to rectal cancer surgery. The aim of this experimental study was to investigate the impact of selective surgical pelvic autonomic nerve damaging on the evoked IONM signal of the IAS. Methods: For this purpose 12 pigs underwent low anterior rectal resection. The pelvic splanchnic nerves were identified by means of electric stimulation under continuous electromyography of the IAS. For standardized neurostimulation, currents of 3 mA, frequency of 30 Hz and monophasic rectangular pulses with pulse duration of 200 μs were chosen. Surgical autonomic nerve damaging was performed on both pelvic sides while recording the evoked IONM signal of the IAS. Nerve damaging was carried out proximal to the stimulation point at the level of the pelvic splanchnic nerves and then distally at the level of the inferior hypogastric plexus. Scissors, monopolar diathermy, ultracision and waterjet were used for nerve damaging, each in 3 animals. Results: Selective instrumental nerve damaging during neurostimulation resulted in a dissection specific superimposed artefact followed by a change in the evoked electromyographic amplitude, which could be observed online on the monitor of the IONM device. Comparison of the recorded IONM signals before and after proximal nerve damaging demonstrated a significant decrease in the evoked amplitude level (median 2.8 μV (interquartile range (IQR) 1.6; 5.7) vs. median 1.4 μV (IQR 0.6; 2.9), (p=0.026)). Nerve damaging performed distally to the stimulation point resulted in absence of evoked IONM signals. Conclusion: The present study provided first differentiated insights into the dynamic IONM signal behaviour in response to selective pelvic autonomic nerve damaging. Further studies with neurophysiological and surgical IONM signal analysis are mandatory to reach a more accurate IONM resulting in effective nerve sparing pelvic surgery.

Effect of muscle stretching on meat quality of biceps femoris from beef

The objective of this study was to examine the effect of muscle stretching on meat quality and ultrastructure of biceps femoris (BF) from beef. After slaughter, the right side of the carcasses were suspended from the Achilles tendon (AS; n=10), while the left sides were re-hanged from the pelvic bone (PS; n=10). Meat quality was evaluated by water holding capacity (WHC), cooking loss (CL), color, shear force (SF) and sarcomere length (SL). As a result, PS had no impact on WHC, CL and color parameters. PS significantly decreased SF values by 7.5% only at 2days postmortem. At pelvic suspended sides, SL was increased by 0.13μm, 0.14μm and 0.12μm at 2, 7 and 10days postmortem, respectively (P<0.001). Electron microscopy showed that the ultrastructure of BF have longer sarcomeres and smaller fiber diameter after PS. In conclusion, PS is a useful method for improving tenderness by stretching muscles.

Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation.

Branching patterns of the male internal iliac artery: imaging findings

The aim of this study was to establish the imaging findings of the main branching patterns of the male internal iliac arteries, using different imaging modalities (angio MR, angio CT and digital angiography). Twenty-one males (mean age 73.2years) underwent imaging evaluation with angio MR, angio CT and digital angiography to define the internal iliac artery anatomy before selective embolization of the pelvic arteries. All three modalities were used in 3 patients, angio MR and digital angiography in 17 patients, angio CT and digital angiography in 6 patients and only angio CT in 1 patient. Internal iliac arteries were classified into four groups using the Yamaki classification (modified from the Adachi's classification). Twenty-six pelvic sides were classified as Group A (61.9%), 13 as Group B (31%) and 3 as Group C (7.1%) with no cases of Group D found. Angio MR, angio CT and digital angiography were able to detect most branches of the internal iliac artery. Group A was the most frequent internal iliac artery branching pattern. Angio CT showed better detailed anatomy than angio MR and digital angiography was considered the gold-standard. Non-invasive vascular imaging with angio MR or angio CT is essential before invasive interventions, allowing better planning of the procedure.

Holographic Analysis of the Human Pelvis

Twelve fresh human pelves with preserved lumbar spines, hip joints, and ligaments, were tested by double-exposure and sandwich-hologram interferometry. During physiologic loadings (50-300 N), the pelvis moved as a whole downward and backward. Iliac wings exhibited marked undulation, except for the central part, which showed minor deformations. The sacrum moved downward and rotated forward over an axis 5-9 cm below the promontorium. Removal of the sacroiliac interosseous ligaments eliminated all joint movements and caused a tighter contact between articular surfaces. Removal of the sacrotuberous and sacrospinous ligaments had no influence on the pelvic behavior. The magnitudes of deformations as well as their underlying mineral contents were unequally distributed between the two pelvic sides. These results indicate that the sacroiliac interosseous ligaments are the main determinant of sacral movement. Asymmetric load transmittance to the hip joints might be responsible for the mineral content differences between the pelvic sides.

Effect of electrical stimulation, hip suspension and ageing on quality of chilled pig meat

Carcasses from 60 Large white pigs, weighing 62–85 kg, were split and half were stimulated (700 V, 12·5 Hz for 90 s) 20 min after slaughter. Half of the stimulated ( ES) and half of the non-stimulated sides were suspended from the Obturator foramen at 40 min after slaughter and resuspended from the Achilles tendon after 6 h. The sides were then subjected to one of two chilling treatments: (a) air at −15°C until M. longissimus dorsi (LD) in the lumbar region was below 10°C (approx. 3 h from slaughter), followed by air at 1°C for the remainder of chilling; (b) air at 1°C throughout. Rapid chilling increased toughness of LD but not M. semimembranosus (Sm). Stimulation improved tenderness in both muscles, increased drip loss in Sm and increased paleness in LD which could be reversed by rapid chilling. Pelvic suspension reduced drip and improved tenderness with similar magnitude to ES. Ageing improved tenderness in all except pelvic suspended sides but ES produced the most tender pork at 7 days.