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Surgical and Radiologic Anatomy

, Volume 40, Issue 7, pp 729–734 | Cite as

Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women

  • E. Chantalat
  • C. Vaysse
  • M. C. Delchier
  • B. Bordier
  • X. Game
  • P. Chaynes
  • E. Cavaignac
  • M. Roumiguié
Anatomic Bases of Medical, Radiological and Surgical Techniques
  • 76 Downloads

Abstract

Objective

In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy.

Patients and methods

We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre- and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries.

Results

The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin.

Conclusion

The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.

Keywords

Cystectomy Sexual dysfunction Umbilical artery Urinary bladder Women 

Notes

Acknowledgements

We would like to thank Dr Lucie Even for help in collecting the data.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest to declare.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General and Gynaecological SurgeryRangueil University HospitalToulouseFrance
  2. 2.Department of RadiologyRangueil University HospitalToulouseFrance
  3. 3.Department of Urological SurgeryClinique PasteurToulouseFrance
  4. 4.Department of Urological SurgeryRangueil University HospitalToulouseFrance
  5. 5.Department of NeurosurgeryPierre Paul Riquet University HospitalToulouseFrance
  6. 6.Department of Orthopedic SurgeryPierre Paul Riquet University HospitalToulouseFrance
  7. 7.Laboratory of Applied AnatomyRangueil University HospitalToulouseFrance

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