Pudendal Artery Research Articles

Imaging patterns of the arterial supply of the prostate gland in adult Ghanaian men.

Prostatic arterial embolization (PAE) is a novel procedure in West Africa and Ghana. A thorough understanding of the prostate artery's (PA) anatomy and pattern is required for successful prostatic arterial embolization and to guarantee targeted intervention. This study focuses onprostate arterial supply in adult males, including prevalence, variability, and imaging pattern. A prospective cross-sectional study was conducted, at Euracare Advanced Diagnostics and Heart Centre. Patients who presented for Computed Tomography Angiography of the pelvis were included in the study. A total of 52 males were included and 104 pelvic CT angiography (one for each side) were analyzed, including: prostatic artery diameter, prostatic gland volume and prostate artery branching pattern. The PA branching pattern was classified using de Assis et al. classification. Thirty-seven (71.15%) men had enlarged prostate volume (>30ml). On each side there was only one prostatic artery and no accessory one was found. Only three types of arterial branching were identified: type I, II,III. The type I artery was the most common origin 58.7% (61/104). PA originating from the anterior division of the internal iliac artery (type II) and the type III is from the internal pudendal artery, accounted for 16.3% (17/104) and 25% (26/104) respectively. The most frequent type of PA origin was type I followed by type III then II. Knowing the different and most frequent types of anatomy of PA may help standardization and effectiveness of the PAE in developing countries.

Piezo1 activation induces relaxation of the pudendal artery and corpus cavernosum.

Piezo1 channel is a sensor for shear-stress in the vasculature. Piezo1 activation induces vasodilation, and its deficiency contributes to vascular disorders, such as hypertension. In this study, we aimed to determine whether Piezo1 channel has a functional role in the dilation of pudendal arteries and corpus cavernosum (CC). For this, male Wistar rats were used, and the relaxation of the pudendal artery and CC was obtained using the Piezo1 activator, Yoda1, in the presence and absence of Dooku (Yoda1 antagonist), GsMTx4 (non-selective mechanosensory channel inhibitor) and L-NAME (nitric oxide synthase inhibitor). In the CC, Yoda1 was also tested in the presence of indomethacin (non-selective COX inhibitor) and tetraethylammonium (TEA, non-selective potassium channel inhibitor). The expression of Piezo1 was confirmed by Western blotting. Our data show that Piezo1 activation leads to the relaxation of the pudendal artery and CC as the chemical activator of Piezo1, Yoda1, relaxed the pudendal artery (47%) and CC (41%). This response was impaired by L-NAME and abolished by Dooku and GsMTx4 in the pudendal artery only. Indomethacin and TEA did not affect the relaxation induced by Yoda1 in the CC. Limited tools to explore this channel prevent further investigation of its underlying mechanisms of action. In conclusion, our data demonstrate that Piezo1 is expressed and induced the relaxation of the pudendal artery and CC. Further studies are necessary to determine its role in penile erection and if erectile dysfunction is associated with Piezo1 deficiency.

Phallus Preservation for Locally Advanced Proximal Primary Urethral Carcinoma: Technique and Outcomes

To describe a novel method of penile sparing perineal urethrectomy for locally advanced proximal primary urethral cancers (PUC). In mid-2021, 2 cases underwent pelvic exenterative surgery for pT3 and pT4 PUC. The procedure comprised of a complete urethrectomy, proximal penectomy, en bloc pubectomy and excision of pelvic diaphragm in both cases. One case included a wide excision of scrotum, whilst the other required a prostatectomy and abdominoperineal resection of the rectum to achieve complete tumor resection. A complete R0 resection was achieved in both cases. At 6 months follow up, there is no evidence of ischemic necrosis of the penis and cosmesis is satisfactory to both patients. We provide a comprehensive operative description of both cases, together with illustrations, and discuss the underlying principles of penile preservation in the surgical treatment of locally advanced proximal PUC. Complete perineal urethrectomy with phallic preservation is feasible in men with locally advanced proximal bulbar urethral cancer in the absence of tumor invasion of the penile shaft. The remnant penis survives off arterial supply from the superficial penile arteries arising from the external pudendal arteries. Phallic preservation may benefit patient's psychological quality of life post-procedure.

The Middle Rectal Artery: Revisited Anatomy and Surgical Implications of a Neglected Blood Vessel.

Although the middle rectal artery is a relevant anatomical landmark for rectal resection and lateral lymph node dissection, descriptions of this entity are highly divergent. Dissection, visualization, morphometry, and 3-dimensional reconstruction of the middle rectal artery to facilitate its management in surgery. Macroscopic dissection, histologic study, morphometric measurements, and virtual modeling. University laboratory of applied surgical anatomy. This study includes formalin-fixed hemipelvis specimens (n=37) obtained from body donors (age, 67-97 y). The main outcome measures are photo documentation of origin, trajectory, diameter, and branching pattern; immunolabeling of lymphatics; and 3-dimensional reconstruction of the middle rectal artery. The middle rectal artery was present in 71.4% of body donors (21.4% bilateral, 50% unilateral), originated from the anterior division of the internal iliac artery, and branched either from the internal pudendal artery (45.5%), the inferior gluteal artery (22.7%), the gluteal-pudendal trunk (22.7%), or a trifurcation (9.1%). One to 3 branches of varying diameters (0.5-3.5 mm) entered the mesorectum from the ventrolateral (35.7%), lateral (42.9%), or dorsolateral (21.4%) aspect. The middle rectal artery was accompanied by podoplanin-immunoreactive lymphatic vessels and gave off additional branches (81.8%) to the urogenital pelvic organs. Three-dimensional reconstruction revealed the complex course of the middle rectal artery from the pelvic sidewall through the pelvic nerve plexus and parietal pelvic fascia into the mesorectum. Findings retrieved from body donors may be prone to age- and fixation-related processes. The investigation disclosed the rather high prevalence of the middle rectal artery, its 3-dimensional topographic anatomy, and its proximity to the autonomic pelvic nerves. These features play a role in the surgical management of this blood vessel. The data provide the anatomical rationale for the lateral lymphatic spread of rectal cancer and an anatomical basis for nerve-preserving lateral lymph node dissection.

Erectile dysfunction and angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery stenosis in patients with suspected coronary artery disease: a retrospective study

This study aimed to assess the angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery (II-IPA) stenosis and evaluate its association with erectile dysfunction (ED). We reviewed the data of 91 patients who had undergone pelvic angiography (PA) to evaluate II-IPA stenosis and coronary angiography (CAG) due to suspected coronary artery disease. Erectile function (EF) was evaluated using the International Index of Erectile Function before CAG and PA. CAG was performed first, followed by PA of the bilateral II-IPA. Regardless of the location and number of stenosis sites, based on CAG, we categorized the patients into two groups. Patients with a maximum stenosis <50% and ≥50% on CAG were assigned to Group I and Group II, respectively. Then, the EF domain score and the diameter stenosis (DS) of II-IPA were evaluated and compared. Overall, 55 patients comprised Group I, while 36 patients comprised Group II. ED was present in 96.3% and 97.2% of the patients in Group I and II, respectively. There was no statistical difference between the groups in the severity of ED (p = 0.457). PA revealed that 14.5% and 36.1% of patients in Groups I and II had ≥50% stenosis of the II-IPA. The mean DS of II-IPA in Group II was greater than that in Group I (p = 0.017). There was a statistically significant correlation between the degree of coronary artery stenosis and the degree of II-IPA stenosis (r = 0.295, p = 0.005). This study revealed that coronary artery stenosis correlates with II-IPA stenosis. The presence and degree of coronary artery stenosis or II-IPA stenosis indicate the necessity for more active treatment in patients with ED.

Vulvar Reconstruction Using Keystone Flaps Based on the Perforators of Three Arteries.

Various flaps are used to reconstruct skin and soft tissue defects of the vulva following resection of malignancies. Whenever possible, reconstruction using local flaps is the standard treatment. Here, we describe vulvar defect reconstruction using keystone flaps. Standard keystone flaps are based on randomly located vascular perforators. However, we designed a keystone flap that includes perforators of three named arteries (the anterior labial artery of the external pudendal artery, cutaneous branches of the obturator artery, and posterior labial artery of the internal pudendal artery) and the pudendal nerve, which accompanies the internal pudendal artery. Four patients with squamous cell carcinoma and extramammary Paget's disease of the vulva underwent radical vulvectomy and keystone flaps including perforators of three arteries. Depending on the morphology of the defects, keystone flaps were used with different designs. For elliptical and unilateral vulvar defects, a standard keystone flap was designed, and for defects on both sides of the vulva, a double opposing keystone flap was used. For oval defects, the omega variant keystone flap was designed, and when the morphology of the defect needed rotation of the flap, a rotational keystone flap was designed. All the patients showed good function and sensation, with an acceptable cosmetic appearance.

Effectiveness of transarterial embolisation for intractable postpartum haemorrhage in a disseminated intravascular coagulation state, despite emergency hysterectomy

We evaluated the effectiveness of transarterial embolization (TAE) for intractable postpartum hemorrhage in patients with disseminated intravascular coagulation (DIC) despite emergency hysterectomy. We retrospectively assessed TAE performed after emergency hysterectomy in 15 patients between July 2008 and January 2022. Underlying condition, technical success, clinical success, angiographic findings, laboratory findings, pregnancy-modified DIC score (The International Society on Thrombosis and Haemostasis), blood transfusion, ICU (Intensive care unit) admission day, hospital day, in-hospital mortality, and long-term sequelae were evaluated. All patients were diagnosed with DIC before embolization, with a 43.9 mean DIC score. All patients showed positive angiographic findings for active bleeding. Thirty-eight bleeding arteries were confirmed. The remnant uterine artery (n=25) was the most common focus of persistent bleeding, followed by the cervicovaginal artery (n=6), pudendal artery (n=3), obturator artery (n=2), vesical artery (n=1), and unspecified artery from the internal iliac artery (n=1). Technical and clinical success rates were 100% (15/15) and 93.3% (14/15), respectively. Mean nadir hemoglobin (Hb) level before embolization was 4.9 g/dL. All patients underwent massive transfusion before embolization (mean 33.2 packs of RBC). Postoperatively, a smaller amount of blood was transfused than before the procedure (mean 10.6 packs of RBC). Mean nadir Hb level after embolization was 8.2 g/dL. There was one instance each of in-hospital death, hypoxic brain damage, and ischemic acute kidney injury. Despite hysterectomy for postpartum bleeding, there could be multiple residual or uncontrolled bleeding foci, especially in case of DIC, for which TAE could be an effective treatment.

A Novel Approach to Vessel-Sparing Prostate Radiotherapy Using MR-Only Simulation and Non-Contrast MR Angiography: Vessel Delineation Feasibility and SBRT Dosimetric Analysis

<h3>Purpose/Objective(s)</h3> Erectile dysfunction is a common side effect of prostate cancer treatment, including prostate radiotherapy (RT). Vessel-sparing RT with avoidance of the internal pudendal artery (IPA) has shown promising rates of erectile function in non-randomized data. Implementation of vessel-sparing RT can be complicated by factors such as difficulty of MRI registration to planning CT and clinical desires to reduce routine use of IV contrast. We optimized a non-contrast MR angiography (ncMRA) sequence and compared IPA delineation on ncMRA with contrast MRA in a cohort of patients undergoing prostate stereotactic body RT (SBRT). We further performed dosimetric analysis on the IPAs. <h3>Materials/Methods</h3> Prostate cancer patients were prospectively enrolled on an IRB-approved MR imaging protocol. Treatment was with SBRT to a dose of 37.5 – 40 Gy in 5 fractions every other day. MR-only simulation was performed including MRA (2D T1w fast field echo (FFE) time-of-flight) and ncMRA (3D T1 FFE, 12 dynamics, temporal resolution = 14 seconds) sequences. Bilateral IPAs were delineated by a single blinded observer on MRA and ncMRA sequences. Analytical comparison between IPA contours on each patient was performed using mean distance to agreement (MDA), Dice similarity coefficient (DSC), and Jaccard index (JI). DSC and JI were also performed on IPA contour expansions of 2mm and 5mm. Dosimetry evaluated D50 and D05 on raw contours and 5mm expansion, and t-test compared dose on MRA and ncMRA. <h3>Results</h3> 10 patients were enrolled; 8 received 40 Gy, and 2 received 37.5 Gy. The median (range) analytical difference between IPA contours on MRA and ncMRA for MDA, DSC, and JI were 2.21 mm (0.99 – 4.16 mm), 0.54 (0.51 – 0.65), 0.37 (0.34 – 0.48), respectively. Using 2 mm contour expansion, DSC and JI were 0.69 (0.61 – 0.77) and 0.53 (0.44 – 0.63), while 5 mm expansion produced DSC and JI of 0.77 (0.69 – 0.85) and 0.62 (0.52 – 0.73). Dosimetrically, there was no difference in left and right IPA D50 or D05 between contours on MRA and ncMRA (Table). On 5mm expansion, the median (range) of D50 and D05 to IPA contours on ncMRA were 16.2 Gy (11.2 – 22.0 Gy) and 26.7 Gy (17.5 – 31.7 Gy). <h3>Conclusion</h3> This study found that delineation of IPAs using ncMRA was feasible and produced contours similar to those delineated on contrast MRA with no dosimetric differences. We feel that this agreement between imaging modalities demonstrates that ncMRA can be used alone for IPA delineation in vessel-sparing RT. Furthermore, the dosimetric findings of this study can serve as a baseline for expected IPA dose in prostate SBRT.

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients.

The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

Long-term administration of resveratrol and MitoQ stimulates cavernosum antioxidant gene expression in a mouse castration model of erectile dysfunction

AimsErectile dysfunction is a common complication within many pathological conditions associated with low testosterone. Testosterone deficiency increases oxidative stress in the penile tissue that contributes to endothelial dysfunction and subsequent erectile dysfunction. Current therapies do not ameliorate oxidative stress so targeting oxidative stress may improve erectile dysfunction. Resveratrol and MitoQ are two prospective drugs that have antioxidant-like properties and may be useful to improve erectile dysfunction induced by androgen deprivation. Materials and methodsWe castrated 12-week-old male C57BL/6 mice and performed an eight-week intervention with oral delivery of resveratrol or MitoQ at low and high doses. We assessed vascular reactivity of the corpus cavernosum and internal pudendal arteries (IPA) through dose-dependent responses to vasodilatory, vasocontractile, and neurogenic stimuli in a myograph system. We performed qRT-PCR to measure expression changes of 18 antioxidant genes in the corpus cavernosum. Key findingsCastration significantly impaired erectile function via impaired endothelial-dependent and-independent relaxation, and increased constriction of the corpus cavernosum, and induced severe endothelial dysfunction of the IPA. Castration decreased expression of 8 of the antioxidant genes investigated. Resveratrol and MitoQ were ineffective in reversing the effects of androgen deprivation on vascular reactivity, however high-dose resveratrol treatment upregulated several key antioxidant genes, including Cat, Sod1, Gstm1, and Prdx3. SignificanceOur findings suggest that oral resveratrol and MitoQ treatment may provide protection to the corpus cavernosum under androgen deprived conditions by stimulating endogenous antioxidant systems. However, they may need to be paired with vasoactive drugs to reverse erectile dysfunction under androgen deprived conditions.

Radiographic Study Evaluating Perforator Vessels in the Ischiorectal Fossa for Safe Elevation of Island Flaps.

Background:Perforator flaps based on the ischiorectal fossa (IRF) (ie, internal pudendal artery perforator flaps) are useful for perineal reconstruction. The three-dimensional characterization of perforator arteries in the IRF remains unclear, as the IRF contains thick adipose tissue as well as organs, such as the rectum, vagina, and urethra. This study aimed to evaluate perforators in the IRF to guide the safe elevation of skin flaps designed based on the IRF.Methods:IRF vessels were examined in 200 bilateral computed tomography angiography scans performed in 100 patients. We examined branching patterns arising from the internal iliac artery and the origins of the skin perforators in the IRF.Results:The branching patterns of the internal iliac artery were divided into three groups: perforators derived exclusively from the internal pudendal artery (78%), perforators derived from the internal pudendal artery and the inferior gluteal artery (18%), and perforators derived exclusively from the inferior gluteal artery (4%). The average number of perforators in the IRF was 1.5 ± 0.7. The number of perforators was significantly higher in women than in men. The perforator arteries were found exclusively around the medial and dorsal sides of the ischial tuberosity.Conclusions:We found that perforators in the IRF were stable. All cases had more than one skin perforator, which was mainly derived from the internal pudendal artery. Although perforators cannot be identified during flap elevation because the fatty tissue in the IRF is very thick, physicians must focus on preserving the perforator-containing fatty tissue around the ischial tuberosity.

Super-selective Gelfoam embolisation in high-flow priapism.

High-flow priapism is a rare condition with limited data in the literature, particularly in Australia. There is therefore no clear consensus regarding treatment. We aim to present our institutional network experience in managing this condition over the last decade with super-selective gelatin sponge (Gelfoam) embolisation of the internal pudendal artery. We retrospectively searched for and reviewed the patient records of all cases of priapism encountered within our multicentre institutional network over the last 10 years. Of these, the cases of high-flow priapism treated with embolisation were analysed in depth and compared with the current literature. Overall, 93 patients in our network were diagnosed with priapism from 1 January 2012 to 1 January 2022. And 89 of these patients (96%) had low-flow priapism and four patients (4%) had high-flow priapism. Of these four patients, two were treated within our network with super-selective Gelfoam embolisation of the internal pudendal artery. Following embolisation, both patients achieved rapid detumescence and returned to baseline premorbid erectile function. There was no report of recurrence or erectile dysfunction on follow-up. Super-selective embolisation of the internal pudendal artery should be considered as a treatment option for high-flow priapism, with Gelfoam as an appropriate temporary embolic agent of choice. We show that it was a safe and effective option for the patients treated in this series, enabling quick and long-term return to baseline erectile function. Our results support data provided by the limited number of cases in the literature.

Urethral pseudoaneurysm life-threatening bleeding: a case report and literature review of etiological and treatment options

BackgroundPseudoaneurysm (PA) of pudendal artery’s distal branches is an extremely rare clinical scenario. We report a case of life-threatening urethrorrhagia due to PA of the internal pudendal artery (IPA).Case presentationA 35-year-old man presented with massive urethral bleeding after traumatic urethral catheterization. Failed attempts of conservative management necessitate an emergency intervention with angiography which shows an active extravasation from the left IPA, which was embolized with gel foam, and complete hemostasis was achieved.ConclusionPA of the pudendal artery’s distal branches is serious, and majority of cases need an emergency intervention. CT angiography is the best diagnostic imaging, and angioembolization of the bleeding site is considered the first-line treatment. Other treatment options such as US-guided compression, endoscopic coagulation, and open surgery are alternative treatments.

S2128 Rectal Ischemia in a Patient After EVAR and COVID-19

Introduction: Ischemic proctitis is a rare, but serious, source of GI bleeding as mortality rates approach 20-40%. Patients for which ischemia should be considered are those with previous surgery, older patients, and those with known peripheral arterial disease. Case Description/Methods: 80-year-old male with history of hyperlipidemia and hypertension presented to the hospital for shortness of breath secondary to COVID-19 pneumonia. His respiratory status continued to decline requiring mechanical ventilation and ICU admission. During his admission, he was found to have acute left lower extremity ischemia requiring stenting of his superficial femoral artery and abdominal endovascular aneurysm repair (EVAR). He was started on anticoagulation with heparin infusion. His hospital course was further complicated large volume maroon-colored stools concerning for lower GI bleed. Colonoscopy was performed at the bedside to further evaluate. In the rectum, there were circumferential ulcerations with inflammation and exudate, extending 10 cm from the anal verge. Biopsies were consistent with rectal ischemia. Unfortunately, soon after the patient developed worsening acidosis requiring CVVHD and increased requirement for pressor support. The family ultimately decided to pursue comfort care and the patient was palliatively extubated (Figure). Discussion: Rectal ischemia is rare as the rectum has blood supply from the inferior mesenteric and bilateral iliac arteries. In our patient, during EVAR graft repair, the IMA was occluded by a stent, the iliac arteries however, remained intact providing the middle rectal and pudendal artery as sources of collateral blood supply. It is hypothesized that a hypercoagulable state caused by COVID-19 infection coupled with ongoing hypotension in the setting of critical illness in our patient with significant peripheral arterial disease led to the low flow state in bilateral iliac arteries causing ischemic proctitis. Rectal ischemia must be considered early in patients because, while most cases of lower GI bleeding can be treated conservatively, rectal ischemia is an indication for prompt surgical intervention. Surgical intervention is required to remove necrotic bowel and potential sources of infection causing septic shock.Figure 1.: Circumferential rectal ischemia as seen by colonoscopy.

Ultrasound diagnosis of arteriogenic erectile dysfunction

Objective . To evaluate the effectiveness of a comprehensive study of the entire arterial tract of erectile function (EF) in patients with arteriogenic erectile dysfunction (ED) to determine the tactics of correction. Material and methods . 83 patient with newly diagnosed organic ED (N48.4 ICD-10) were examined. Ultrasound examination of the arteries of the aorto-iliac segments, transperineal examination of the internal pudendal arteries (IPA), arteries of the penis in a state of de-and tumescence, transrectal examination of the prostatectomy gland (TRUS), multispiral computed tomography (MSCT), angiography of the pelvic arteries in men. Results . A transperineal ultrasound examination of the VPA has been developed, which makes it possible to evaluate important morphometric and hemodynamic features of the artery on the perineum, effectively determine the stenoocclusive lesions of the VPA, while the accuracy of the method is 92.4%, sensitivity is 95.38%, specificity is 89.36%, which is comparable to MSCT angiography. Conclusion . The obtained information about arterial blood flow in the IPA basin using transperineal ultrasound is the advantage of this non-invasive diagnostic method. For the full diagnosis of arteriogenic ED, traditional ultrasound of the IF should be supplemented with ultrasound assessment of the arteries of the aorto-iliac segments, IPA for the study of the entire arterial tract with the subsequent choice of the proper correction tactics.

Application of dual-energy CT angiography in diagnosis of arterial erectile dysfunction: new scanning technology, new scanning area

Objectives To explore the value of dual-energy computed tomography (DE-CT) angiography in diagnosis of arteriogenic erectile dysfunction (ED) patients and feasibility of new scanning area that excludes the testis. Materials and methods Ninety-three patients suspected of suffering arterial ED and 40 health volunteers underwent penile duplex Doppler ultrasound and DE-CT angiography (DE-CTA). The scanning range of DE-CTA covered whole arterial system of pelvis and testis was excluded. Two blinded investigators independently evaluated the arterial system that supplies the penis. Results Finally, 1596 segments were evaluated and 470 segments were judged to be abnormal. The distribution was: 2 (0.4%) in common iliac artery, 7 (1.5%) in internal iliac artery, 82 (17.5%) in internal pudendal artery, 89 (18.9%) in penile artery, 120 (25.5%) in dorsal artery, and 170 (36.2%) in cavernosal artery. The specificity, sensitivity, positive predictive value, and negative predictive value of DE-CTA in diagnostic were 86.02%, 87.50%, 94.12%, and 72.92%. Besides, the new scan area allowed for effective evaluation of the arteries while excluding the testis. Conclusion DE-CTA can provide unbiased, safe evaluation of the vascular status of the penile bed in patients with ED.

Daily online contouring and re-planning versus translation-only correction in neurovascular-sparing magnetic resonance-guided radiotherapy for localized prostate cancer.

Neurovascular bundle (NVB) and internal pudendal artery (IPA) sparing during magnetic resonance-guided radiotherapy (MRgRT) for prostate cancer aims for preservation of erectile function. Our present workflow involves daily online contouring and re-planning on a 1.5 T MR-linac, as alternative to conventional (rigid) translation-only corrections of the prostate. We compared planned dose for the NVB and IPA between strategies. Total planned dose was significantly lower with daily online contouring and re-planning for the NVB, but not for the IPA. For the NVB and IPA, the intrapatient difference between highest and lowest fraction dose was significantly smaller for the contouring and re-planning plans.

Abstract P080: Il-18 Potentiates Contractile Responses To Phenylephrine And Inhibits Relaxation Responses To Acetylcholine In Resistance Arteries From Wistar Rats

Background: The etiology of essential hypertension remains unclear, and its mechanisms are complex. Indeed, low-grade inflammation and activation of the immune system have been implicated in hypertension. Clinical and population studies have consistently found increased circulating levels of interleukin 18 (IL-18) in patients with hypertension. Hypothesis: This study tests the hypothesis that IL-18 will enhance contractile responses to phenylephrine and impair relaxation responses to acetylcholine in isolated arterial rings from rats. Methods: Vascular function was performed on isolated pudendal arteries from male Wistar rats using wire myographs, kept in Krebs solution at 37°C, constantly aerated with 95%O 2 /5%CO 2 . Concentration-response curves to phenylephrine (PE; 10 -9 -3x10 -5 M), and acetylcholine (ACh; 10 -9 - 3x10 -5 M) were performed in the absence or in the presence of IL-18 (20ng/ml) for 1 hour and 6 hours respectively. Ten minutes prior to the incubation with IL-18, some arterial rings were incubated separately with the mitogen-activated protein kinase (MKK / MEK) inhibitor, PD98059 (10 -5 M). Concentration-response curves were analyzed using non-linear regression analysis. Data are presented as mean ± S.E.M. Statistical significance set at p&lt;0.05. Data analyzed with GraphPad Prism 9.2.0. Results: In the pudendal arterial rings, the potency of PE was increased in the presence of IL-18 (pEC 50 6.510 ± 0.3987 vs 6.022 ± 0.2738 for control; p = 0.0268), Incubation with IL-18 plus PD98059 restored the contraction to PE to control levels. (pEC 50 6.105 ± 0.4007 vs 6.170 ± 0.2847 for control; p = 0.7120). Relaxation responses to Ach were impaired by incubation with IL-18 for 6 hours (pEC 50 5.942 ± 0.1575 vs 7.341 ± 0.1796 for control; p=0.0042) Conclusion: Our results show that IL-18 enhances the contractile responses to PE in pudendal arteries from Wistar rats by activation of the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway. Thus, IL-18 may contribute to the increased vascular resistance characteristic of hypertension.

Video 12 - Preservation of accessory pudendal artery during robotic-assisted laparoscopic radical prostatectomy as part of a nerve spare dissection; a video series

Video 12 - Preservation of accessory pudendal artery during robotic-assisted laparoscopic radical prostatectomy as part of a nerve spare dissection; a video series

SEPA Based Flap for Covering Defect after Adult Exstrophy Epispadias Repair

INTRODUCTION&#x0D; Bladder exstrophy is a complex, rare disorder that affects the foetus in utero. Here the abdominal wall is not fully formed, leaving the pubic bones separated and the bladder exposed in the lower abdominal wall.&#x0D; METHODOLOGY&#x0D; Single-stage reconstructive and repair surgery was undertaken in adults diagnosed with bladder exstrophy epispadias complex. The superficial external pudendal artery flap was considered for covering the defect after extensive reviews and discussion.&#x0D; CONCLUSION&#x0D; An uneventful surgery with recovery and a two-year follow-up post-surgery did not account for any complications following the procedure. This shows that the superficial external pudendal artery flap can be considered a favourable option for urologists in the repair of bladder exstrophy epispadias complex when undertaken in a single sitting surgery, especially in adults.&#x0D; MeSH Terms&#x0D; Bladder Exstrophy, epispadias repair, superficial external pudendal artery, axial-pattern flap.