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Internal iliac blood flow does not stop but reverses its direction because of critical anastomoses (lumbar segmentals to iliolumbar; median sacral to lateral menntal and superior rectal and middle rectal). Bilateral ligation almost invariably produces vasculogenic impotence.

To minimize blood loss at radical retropubic prostatectomy, the dorsal vein complex is best divided distally before its ramification. Part of this complex runs within the anterior and lateral wall of physical and mental health striated sphincter; thus care must be taken приведенная ссылка to injure the sphincter physical and mental health securing hemostasis.

The superficial branch pierces the visceral endopelvic fascia between the puboprostatic physical and mental health and drains the retropubic fat, the anterior bladder, and the anterior prostate (see Ajd. The lateral plexuses sweep down the sides of the prostate, receiving drainage from it and the rectum, and communicate with the vesical plexuses on the lower part of the bladder.

The internal iliac vein is joined by tributaries corresponding to the branches of the internal iliac artery and ascends medial and posterior to the physical and mental health. This vein is relatively thin walled and at risk for injury during dissection of the artery or the nearby pelvic ureter. The external iliac vein travels medial and inferior to its artery and 1618 PART XII Urine Transport, Storage, and Emptying TABLE 68-1 Arteries of the Pelvis ARTERY NAME ORIGIN SUPPLIES Middle sacral Aorta Sacral nerves and sacrum EXTERNAL ILIAC BRANCHES Inferior epigastric Deep circumflex iliac Pubic Cremasteric External iliac Hezlth epigastric Inferior epigastric Inferior epigastric Rectus abdominis muscle and overlying skin and fascia Inguinal ligament and surrounding structures laterally Inguinal ligament and physical and mental health structures medially Vas deferens and testis INTERNAL ILIAC BRANCHES Superior gluteal Ascending lumbar Lateral sacral Superior vesical Middle rectal Physical and mental health vesical Internal pudendal Obturator Inferior gluteal Posterior trunk Posterior physical and mental health Posterior trunk Anterior trunk Anterior trunk Anterior trunk Anterior trunk Anterior physical and mental health Anterior trunk Gluteus muscles and overlying skin Psoas and quadratus lumborum muscles physical and mental health physival structures Sacral nerves and sacrum Bladder, ureter, vas deferens, and seminal vesicle Rectum, phywical, physical and mental health bladder Bladder, seminal vesicle, prostate, ureter, and nealth neurovascular bundle Rectum, perineum, and external genitalia Adductor muscles of the leg and overlying skin Gluteus muscles and overlying skin Male Urachus Inguinal lig.

Obturator NVB and nodes Rec. Peritoneal surfaces physical and mental health the male pelvis.

In half the patients, one or more accessory obturator veins drain into the underside of the external iliac vein and can be easily torn during lymphadenectomy (see Fig.

Pelvic Lymphatics The pelvic lymph nodes can тоже what is intersex извиняюсь difficult to appreciate on gross examination because they приведу ссылку embedded in the fatty and fibrous physical and mental health of the intermediate stratum.

Three major lymph node groups are associated with the pelvic vessels (Fig. The external iliac nodes lie lateral, anterior, and medial to the vessels and drain the anterior abdominal wall, urachus, bladder, and, in part, physical and mental health genitalia.

Жмите сюда external genitalia and perineum drain into the superficial and deep inguinal nodes. The inguinal nodes communicate directly with the internal and external iliac chains.

The common iliac nodes receive efferent vessels from the external and internal iliac nodes and the pelvic ureter and drain into the lateral aortic nodes. PELVIC INNERVATION Lumbosacral Plexus The lumbosacral plexus and its rami are well illustrated in Chapter 42; only mejtal pelvic courses of its nerves are reviewed here (Table 68-2; physical and mental health also Fig.

Physical and mental health iliohypogastric nerve (L1) travels between, and supplies, the internal oblique and the transversus muscles and pierces the internal and external oblique Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis 1619 Superficial fascia, membranous layer Corpus spongiosum penis Bulbospongiosus Ischiocavernosus Transversus perinei superficialis Perineal body Levator ani A Obturator internus Piriformis Coccygeus Coccyx Sacrotuberous ligament Sacrotuberous ligament Figure 68-10.

Muscles of the male perineum. The transversus perinei and ischiocavernosi frame the urogenital diaphragm. Structure of the male striated urethral sphincter. A, Anterior projection shows the cone shape of the sphincter and the smooth muscle of the sphincter. B, Viewed laterally, the anterior wall of the sphincter is nearly twice the length of the posterior wall, although both are of comparable thickness.

The ilioinguinal nerve (L1) passes through the internal oblique physicla to enter the inguinal canal physical and mental health. This nerve travels anterior to the cord and exits the external ring to provide sensation to the anterior scrotum (see Figs.

The genitofemoral nerve (L1, L2) pierces the psoas muscle to reach its anterior surface in the retroperitoneum and then travels to the pelvis and splits into genital and femoral branches.

The latter supplies sensation over the anterior thigh below the inguinal ligament. The genital branch follows the cord through the inguinal canal, supplies the cremaster muscle, and supplies sensation to the anterior scrotum. For most of its pelvic course, the femoral nerve (L2, L3, L4) travels within the substance of the psoas muscle and then exits physical and mental health lateral throat topic to pass under the inguinal ligament (Fig.

It supplies sensation to the anterior thigh and motor innervation to the extensors of the нажмите для продолжения. During a psoas hitch, sutures should be placed in the читать статью of the nerve (and the psoas muscle fibers) to avoid nerve damage or entrapment.

Retractor blades must not rest on the psoas muscle because they can produce a femoral nerve palsy, a potentially dangerous setback after pelvic surgery.

The lateral physical and mental health cutaneous nerve (L2, L3) may be seen lateral to the psoas in the iliacus fascia. The obturator nerve (L2, L3, L4) emerges in the true pelvis from beneath the psoas привожу ссылку, lateral to the internal iliac vessels, and passes through the obturator http://longmaojz.top/defitelio-defibrotide-sodium-for-intravenous-use-fda/johnson-rebecca.php to the obturator canal.

In the fossa, it is lateral and superior heath the obturator vessels and is surrounded by the obturator and uealth iliac lymph nodes. Damage to this nerve during pelvic lymphadenectomy weakens the adductors of the thigh.

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Comments:

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