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Pelvic Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Arterial bleedSuperior gluteal artery is the most common source in APC-III injury and posterior ring disruption.Obturator artery.Internal pudendal artery.
Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
While not as common as infrainguinal occlusive disease, atherosclerotic occlusive aortoiliac disease remains a common cause of lower extremity ischemic symptoms in middle age and elderly patients. Though aortoiliac occlusive disease alone is rarely the cause of critical limb ischemia due to sufficient collateral circulation, it can result in disabling claudication involving the hips, buttocks, thighs, and calves. Critical limb ischemia may develop when this disease pattern develops in conjunction with infrainguinal disease. In males, this can also lead to impotence as a result of internal pudendal artery hypoperfusion. The triad of Leriche's syndrome is described as impotence, thigh and buttock claudication, and decreased femoral pulses, and should warrant a search for aortoililac occlusive disease. Aortoililac plaque can also be the cause of the microembolization of atherosclerotic debris to the terminal vessels in the feet, causing “blue toe syndrome” and leading to significant pain and potentially tissue loss despite adequate resting perfusion pressures and sometimes intact distal pulses.
Erectile Dysfunction
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Mark Johnson, Marco Falcone, Tarek M. A. Aly, Amr Abdel Raheem
In most cases, the diagnosis of ED is clinical; however, some patients may need additional diagnostic evaluation. Nocturnal penile tumescence and rigidity test (NPT): The NPT assesses the presence of any penile tumescence and erection during night. It may facilitate differentiating between an organic or a psychogenic ED [31].Dynamic duplex ultrasound of the penis (Figure 12.2): Penile duplex (after the endocavernous injection of a full-dose of alprostadil) allows the verification of the vascular status of the penis. It aids in determining whether ED is due to vascular (arterial or venous due to corporal occlusive mechanism alteration) or psychogenic causes [32,33].Arteriography: A selective internal pudendal arteriography is recommended in patients with a de novo diagnosis of arterial ED following a pelvic or perineal trauma; it may identify a posttraumatic internal pudendal artery occlusion. If this is the case, a penile revascularization (arterial bypass) is indicated [34].
Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause
Published in Climacteric, 2020
J. Mercier, M. Morin, A. Tang, B. Reichetzer, M.-C. Lemieux, K. Samir, D. Zaki, F. Gougeon, C. Dumoulin
As hypothesized, blood flow in the internal pudendal artery and the dorsal clitoral artery improved at rest. This implies that more blood goes through the internal pudendal artery and its terminal branches at each cardiac cycle. Training other skeletal muscles has been previously shown to increase blood flow in both the main artery and their terminal branches in postmenopausal women. Nyberg et al. observed increased blood flow velocity at rest in the femoral artery of postmenopausal women after leg muscle training24. Gavin et al. found an increased capillary density in the trained muscle (the quadriceps) in the same population25. Blood flow of the internal pudendal artery and the dorsal clitoral artery also improved after the maximal PFM contraction task. This implies that those vessels enhanced their capacity of adaptation to meet the muscle’s needs after PFM activation. The internal pudendal artery provides blood to the PFM, the vagina, the vulva, the clitoris, and the perineum. Therefore, an increase in blood flow at rest and after PFM activation in this artery should provide more blood to these structures and impact them. This hypothesis is supported by the significant increase in vaginal secretions and improved color of the vaginal epithelium after a PFMT program5, as well as increased thickness of vaginal mucosa using the Vaginal Atrophy Index. These changes may be related to a reduction in GSM symptoms, such as vaginal dryness and vaginal pruritus.
Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects
Published in The Aging Male, 2018
Aldo E. Calogero, Giovanni Burgio, Rosita A. Condorelli, Rossella Cannarella, Sandro La Vignera
The penile arterial supply displays slight variation in its anatomy. The penis is usually supplied by branches of the internal pudendal artery, which continue as the penile artery. The bulbar artery supplies the proximal shaft and is the first branch of the penile artery, which then divides into the dorsal and cavernosal arteries. The cavernosal artery enters and supplies the corpora cavernosa via several helicine arteries, which in turn flow into the sinusoids via multiple arterioles. The intercavernous septum is perforated, allowing for communication of blood (and injected pharmacological agents) across the midline. Emissary veins pierce the tunica albuginea to drain into the deep dorsal vein, via the spongiosal, circumflex and cavernosal veins [4] (Figure 1).
Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when?
Published in Climacteric, 2023
J. Mercier, C. Dumoulin, G. Carrier-Noreau
Postmenopausal women experience atrophy of blood vessels located in the lamina propria of the vaginal epithelium, which leads to a reduction of blood flow [46]. In our study, vulvovaginal blood flow was assessed before and after PFMT using a color Doppler ultrasound of the main vessel irrigating both the vulvovaginal tissues and PFM, the internal pudendal artery and one of its terminal branches, the dorsal clitoral artery. After PFMT, an improvement in blood flow in both arteries was found at rest [45]. This implies that more blood goes through the internal pudendal artery and its terminal branches at each cardiac cycle. Training of other skeletal muscles, such as the quadriceps, has been previously shown to increase blood flow in both the main artery and their terminal branches in postmenopausal women [47] as well as increase capillary density in the trained muscle [48]. After the intervention, results also showed an improved blood flow adaptation after a PFM contraction task in both arteries. This implies that these blood vessels enhanced their adaptive capacity after PFMT to meet the muscle’s needs after their activation. The internal pudendal artery provides blood to the PFM, vagina, vulva, clitoris and perineum. Therefore, an increase in blood flow in this artery at rest and after PFM activation should provide more blood to these structures and impact their function. This hypothesis is supported by the significant increase in vaginal secretions, improved color of the vaginal epithelium and increased thickness of the vaginal mucosa found after the PFMT program in our study [22]. These changes may reduce GSM symptoms, such as vaginal dryness and vaginal pruritus.