Internal Pudendal Artery
Original Editor - Rana Muhammad Tahir Aslam
Top Contributors - Rana Muhammad Tahir Aslam
Description
The word Pudendal comes from the Latin word "pudendum" which translates into "thing to be ashamed of"In ancient English, this word was used to describe "genitals" especially of Females.[1] The internal Pudendal artery (IPA) is the branch of the anterior division of the Internal Iliac Artery. It is the major supply of blood to the perineal region.[2] The internal pudendal artery is larger in men as compared to females.[3]
Course
Origin:
It originates from the anterior division of the internal iliac artery and passes inferolaterally.[3]
Pathway:
It passes anterior to the piriformis muscle and Sacral plexuses. It exits the pelvic region through the Greater Sciatic foramen, inferior to the piriformis muscles. IPA then goes around the sacrospinous ligament and passes through the Lesser Sciatic foramen to enter the Ischioanal Fossa. It then passes through the Pudendal canal in the lateral wall of the Ischianal Fossa, along with the branches of the Pudendal Nerve and Internal Pudendal Vein.[3]
Terminal Branches
It exits the pudendal canal medial to the ischial tuberosity and divides into 2 branches.[3]
- Perineal Artery
- Dorsal Arteries of Penis (in Males) and Clitoris (in Females)
For a detailed course of the artery and other blood vessels of the pelvic region watch this video:
Branches
The branches of IPAs are as follows:[3]
- Perineal Artery: It is the terminal branch of the IPA and supplies the muscles of the superficial perineal pouch. It also supplies the skin of the scrotum (in males) and labia minor & majora (in females) through its branch.
- Dorsal Arteries of Penis (in Males) and Clitoris (in Females): This is also the terminal branch of IPA but it supplies the corpus spongiosum in males and adjacent skin and fascia of external genitals both in males and females.
- Perforator Branches of Internal Pudendal Artery: These skin perforator branches of IPA are present in the Ischiorectal triangle (also known as the Vascular triangle) and are protected by the thick fatty tissue.[5]
Function
It is the main artery of the Perineal Region. It supplies the blood to the Perineum, Skin of the Anal region, Skin of the Urogenital Triangle, and Muscles in the Anal and Urogenital region. It also supplies blood to the erectile bodies of the external genitals.[3]
Clinical Relevance
- The Internal pudendal artery is at risk of injury and bleeding in the "open book" Hip Bone fractures.[6]
- Trauma can lead to non-obstetric injuries of the perineum. In females, the vulva is at the risk of hematoma due to a rich blood supply. The temporary embolisation of the internal pudendal artery can be done to prevent vulva and labial necrotic damage in these cases.[7]
- According to studies conducted in 2022, radiation damage to the Internal Pudendal Arteries and Neurovascular bundles can cause Erectile Dysfunction. In the studies, the Radiation damage was from the radiation therapy for treating Prostate Cancer.[8]
- The perforator branching arteries of the IPA have anatomical localisation and distribution differences, based on gender. Women have more perforators in the anterior-central region (70.5%), while men have more in the central-posterior region (53.7%).[9]Understanding these gender-specific anatomical distributions improves flap design and surgical outcomes in perineal reconstruction, reducing operative time and complications.
References
- ↑ Harper, Douglas. "Pudendum". Online Etymology Dictionary https://www.etymonline.com/word/pudendum
- ↑ Wineski LE. Snell's clinical anatomy by regions. Lippincott Williams & Wilkins; 2024 Jan 2.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Agur AM, Dalley AF. Moore's essential clinical anatomy. Lippincott Williams & Wilkins; 2022 Dec 29.
- ↑ Anatomy Zone. Internal Illiac Artery. Available from: https://www.youtube.com/watch?v=4Fp2gLbwBDs&t=30s [last accessed 20/10/2024]
- ↑ Hashimoto I, Goishi K, Abe Y, et al. The internal pudendal artery perforator thigh flap: a new freestyle pedicle flap for the ischial region. Plast Reconstr Surg Glob Open. 2014https://www.ncbi.nlm.nih.gov/pmc/articles.
- ↑ Elhence A, Gahlot N, Gupta A, Garg P. Internal Pudendal Artery Injury Following An Open Book Pelvic Fracture: A Case Report. Malays Orthop J. 2020 https://pubmed.ncbi.nlm.nih.gov
- ↑ Zarour CC, Fuguet D, Zaki-Metias KM, et al. Internal pudendal artery embolization for management of a traumatic labial hematoma. https://pubmed.ncbi.nlm
- ↑ Teunissen FR, Wortel RC, Wessels FJ, Claes A, van de Pol SM, Rasing MJ, Meijer RP, van Melick HH, de Boer JC, Verkooijen HM, van Zyp JV. Interrater agreement of contouring of the neurovascular bundles and internal pudendal arteries in neurovascular-sparing magnetic resonance-guided radiotherapy for localized prostate cancer. Clinical and translational radiation oncology. 2022 Janhttps://www.sciencedirect.com/science/article
- ↑ Sonda, Regina MD*; Monticelli, Andrea MD*; Dalla Venezia, Erica MD*; Giraudo, Chiara MD†; Giatsidis, Giorgio MD, PhD‡; Bassetto, Franco MD*; Macchi, Veronica MD§; Tiengo, Cesare MD*. Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction. Plastic and Reconstructive Surgery - October 2020. https://journals.lww.com/prsgo/fulltext/2020