Arteria Pudenda
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The superficial external pudendal artery (superficial external pudic artery) is one of the three pudendal arteries. It arises from the medial side of the femoral artery, close to the superficial epigastric artery and superficial iliac circumflex artery.
After piercing the femoral sheath and fascia cribrosa, it courses medialward, across the spermatic cord (or round ligament in the female), to be distributed to the integument on the lower part of the abdomen, the penis and scrotum in the male, and the labium majus in the female, anastomosing with branches of the internal pudendal artery.It crosses superficial to the inguinal ligament.
Around 70% of men have an accessory internal pudendal artery.[1] This usually does not originate from the internal iliac artery, instead originating from the external iliac artery, the obturator artery, or the vesical arteries.[1]
The internal pudendal artery is a terminal branch of the anterior division of the internal iliac artery. It is considered to be the main artery of the perineum in both sexes. The internal pudendal artery has a relatively long course, passing through the three different regions, including the pelvis, gluteal region and the perineum where it terminates.
The internal pudendal artery is a smaller terminal branch of the anterior division of the internal iliac artery originating between the iliopectineal line and greater sciatic notch. For didactic purposes, the course of the internal pudendal artery can be divided into three parts;
In some cases, an additional perineal artery can be present. It is referred to as the accessory pudendal artery and it usually arises from the pelvic segment of the internal pudendal artery. It can be unilateral or bilateral, as a single or double vessel on each side. The rates of presence of this artery vary across literature, from 10-30%. This artery can provide some of the branches that usually arise from the internal pudendal artery.
In the pelvis of a 78 year old man there have been observed deviations in the origin and course os some parietal branches of the A. iliaca interna dextra. Apart from this typically arising and passing branches (the A. glutaea superior dextra, the A. glutaea inferior dextra, the A. umbilicalis dextra) an atypical stem--the Truncus pudendo-obturatorius--comes out of the A. iliaca interna dextra. This stem divides into the A. obturatoria dextra and the A. pudenda accessoria. The A. pudenda accessoria goes through the pelvis and through the fissure between Symphysis and the Diaphragma urogenitale on the Radix penis as the A. dorsalis penis dextra. The A. pudenda interna dextra comes out of the A. pudenda accessoria in a quite atypical way. It enters the fossa ischiorectalis through the fissure in the hind part of the Arcus tendineus m. levatoris ani ventrally from the Spina ischiadica. Its terminal part goes to the right Corpus cavernosum penis as the A. profunda penis dextra. The parietal branches of the A. iliaca interna sinistra arise and go in a typical way. The A. pudenda accessoria is not formed on the left side of the pelvis.
Objective: It is controversial whether unilateral interruption of the arteria iliaca interna distal end affects penile hemodynamics and erectile function. The purpose of this study was to prospectively evaluate this influence by detecting the blood flow of the penile artery before and after renal transplantation.
Results: The patients ranged in age from 21 to 55 years, of whom 36% had erectile dysfunction (ED) during MHD, and 33% after renal transplantation. A total of 67% of the renal transplant recipients (RTR) complained of unchanged and 15% deteriorated ED, while 18% admitted improved erectile function. The patients showed a significantly stronger sexual desire after the transplantation than before it (6.2 +/- 1.6 vs 8.9 +/- 0.9, P < 0.01). There was a significant decrease in peak systolic velocity (PSV) in the cavernous arteries after transplantation as compared with pre-transplantation (P < 0.01). Penile arterial blood flow insufficiency was found in none of the RTRs.
Conclusion: Unilateral interruption of the internal iliac artery decreases penile arterial blood flow, but not to such a degree as to result in ED. Unilateral interruption of the arteria iliaca interna distal end does not affect the erectile function of RTRs.
SUMMARY: The ischiatic artery classically described as a branch of the inferior gluteal artery, is a long and thin vessel that is related to the ischiatic nerve. In a dissection was observed that this artery emerges from the internal pudendal artery with a caliber larger than the ones described in the literature. The knowledge of anatomical variations is important to the surgeons, radiologists and anatomists.
The internal iliac artery supplies the irrigation for the larger part of pelvis, perineum and gluteal region. Among its branches, there are the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery that go out from the pelvis through the greater ischiatic foramen to the gluteal region (Moore & Dalley, 2004).
In the extrapelvic course of the inferior gluteal artery was observed that one of its branches, called ischiatic artery, is a long and thin vessel that is related to the ischiatic nerve; and that the internal pudendal artery in this region sends only muscular branches to irrigate the muscles of this region (Williams et al, 1979).
In the anatomic piece was observed that this artery started from the internal pudendal artery and its caliber was larger than the ones observed in the pieces of routine studies, and its syntopy with the ischiatic nerve was also different from the ones found and described in the literature.
According to Testut & Latarjet (1975) the ischiatic artery is a branch of anterior trunk of internal iliac artery, located anterior to the internal pudendal artery and goes out from the pelvis, inferior to the pyramidal muscle, what is different from the study of Williams et al. and International Anatomical Terminology (2001) that considers this artery as a branch of inferior gluteal artery, what was not found in our study.
When studied the extrapelvic course of inferior gluteal artery in 80 gluteal regions of 40 adult corpses, Gabrielli et al. (1997) described the importance of knowing the relation of this artery with the ischiatic nerve; and in their studies, they not found a case similar to our, in which the internal pudendal artery sent one branch of large caliber in the direction of the ischiatic nerve, as was observed by us.
Den bakre stammen avgir mindre grener til bekkenets bakre og laterale sider. Den går ut gjennom foramen suprapiriforme (som arteria glutea superior) og forsyner den dype og overflatiske glutealmuskulaturen.
In questo articolo gli Autori descrivono un raro caso di rottura spontanea di arteria iliaca comune in un paziente di 43 anni affetto da sindrome di Ehlers-Danlos. Il quadro clinico, inizialmente subdolo, è evoluto dopo alcune ore in grave shock emorragico.
La sindrome di Ehlers-Danlos presenta un'incidenza di 1 su 5000, rappresentando uno dei più frequenti disordini del tessuto connettivo. La malattia è caratterizzata da una fragilità della parete delle arterie, dell'intestino e dell'utero. La sua presentazione è spesso catastrofica, per rottura di una grossa arteria, rottura dell'utero in gravidanza o perforazione intestinale. La sopravvivenza media dei soggetti affetti da sindrome di Ehlers-Danlos è di 45 anni.
Objectives: The knowledge of penile anatomy is basic to perform a proper diagnosis and direct the most adequate treatment of the various diseases that may appear: urethral stenosis, erectile dysfunction, congenital or acquired penile curvature, etc.; being its anatomical knowledge essential for a proper surgical management. The penis is the male organ involved in both voiding and sexual functions: the body of the penis is composed by three erectile bodies, (i.e the deep structures!: the corpora cavernosa and the corpus spongiosum, this last surrounding and covering the urethra. Buck's fascia is in relation to the deep structures of the penis. The superficial fascia, dartos, is made up from a more areolar tissue and is in relation to skin and vessels. The vascularization of the deep structures comes from the common penile artery, a branch of the internal pudendal artery. Penile blood drains through three venous systems: superficial, intermediate and deep systems. Pudendal nerves are in charge of the sensitive and motor somatic innervations. Cavernosal nerves are a combination of parasympathetic and sympathetic afferent fibers, corresponding to the nerves of the autonomic system of the penis.
La arteria pudenda interna recorre el conducto de Alcock saliendo de la pelvis por el agujero sacrociático mayor y penetrando por el agujero sacrociatico menor dirigiéndose hacia el canal pudendo. Una vez allí se denomina arteria peneana común y pasa a dividirse en sus ramas terminales (1):
La vascularización arterial y venosa, las fibras musculares intrínsecas del pene y la musculatura estriada regional están sometidas a un triple control del sistema nervioso periférico: el sistema simpático, el sistema parasimpático y el somático. Estas múltiples vías, tanto espinales como supraespinales, ejercen el control sobre este sistema periférico (4).
Las eferencias del plexo pélvico proveen inervación para el recto, vejiga, próstata, vesículas seminales, uretra y cuerpos cavernosos. La arteria vesical inferior perfora al plexo aproximadamente en su tercio inferior en dirección a la unión vesicoprostática, para luego irrigar el cuello vesical y la próstata. Casi la totalidad de las fibras nerviosas que quedan por debajo del punto de perforación del plexo por la mencionada arteria, contribuyen a formar el fascículo neurovascular prostático, que van a penetrar hacia el cuerpo esponjoso y a los cuerpos cavernosos para desencadenar los fenómenos neurovasculares durante la ere