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

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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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.

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References

  1. Ali AS, Hayes MC, Birch B, Dudderidge T, Somani BK (2015) Health related quality of life (HRQoL) after cystectomy: comparison between orthotopic neobladder and ileal conduit diversion. Eur J Surg Oncol 41(3):295–299. https://doi.org/10.1016/j.ejso.2014.05.006

    Article  PubMed  CAS  Google Scholar 

  2. Cerruto MA, D’Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M, Niero M, Lonardi C, Bassi P, Belgrano E, Imbimbo C, Racioppi M, Talamini R, Ciciliato S, Toffoli L, Rizzo M, Visalli F, Verze P, Artibani W (2016) Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: Better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol 42(3):343–360. https://doi.org/10.1016/j.ejso.2015.10.001

    Article  PubMed  CAS  Google Scholar 

  3. Chantalat E, Debonnecaze G, Cavaignac E, Chaynes P, Vidal F (2016) Vulvar necrosis after surgical treatment of femoral neck fracture: a case report and investigation of the mechanism of injury. Hip Int 26(1):e4-6. https://doi.org/10.5301/hipint.5000283

    Article  PubMed  Google Scholar 

  4. Chantalat E, Merigot O, Chaynes P, Lauwers F, Delchier MC, Rimailho J (2014) Radiological anatomical study of the origin of the uterine artery. Surg Radiol Anat 36(10):1093–1099. https://doi.org/10.1007/s00276-013-1207-0

    Article  PubMed  CAS  Google Scholar 

  5. Chartier-Kastler EJ, Mozer P, Denys P, Bitker MO, Haertig A, Richard F (2002) Neurogenic bladder management and cutaneous non-continent ileal conduit. Spinal Cord 40(9):443–448. https://doi.org/10.1038/sj.sc.3101346

    Article  PubMed  CAS  Google Scholar 

  6. Collins JW, Wiklund NP (2014) Totally intracorporeal robot-assisted radical cystectomy: optimizing total outcomes. BJU Int 114(3):326–333. https://doi.org/10.1111/bju.12558

    Article  PubMed  Google Scholar 

  7. Elzevier HW, Nieuwkamer BB, Pelger RC, Lycklama a Nijeholt AA (2007) Female sexual function and activity following cystectomy and continent urinary tract diversion for benign indications: a clinical pilot study and review of literature. J Sex Med 4(2):406–416. https://doi.org/10.1111/j.1743-6109.2006.00257.x

    Article  PubMed  Google Scholar 

  8. Game X, Mallet R, Guillotreau J, Berrogain N, Mouzin M, Vaessen C, Sarramon JP, Malavaud B, Rischmann P (2007) Uterus, fallopian tube, ovary and vagina-sparing laparoscopic cystectomy: technical description and results. Eur Urol 51(2):441–446. https://doi.org/10.1016/j.eururo.2006.06.052 (discussion 446).

    Article  PubMed  Google Scholar 

  9. Hobisch A, Tosun K, Kinzl J, Kemmler G, Bartsch G, Holtl L, Stenzl A (2001) Life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion. Semin Urol Oncol 19(1):18–23

    PubMed  CAS  Google Scholar 

  10. Holub Z, Lukac J, Kliment L, Urbanek S (2005) Variability of the origin of the uterine artery: laparoscopic surgical observation. J Obstet Gynaecol Res 31(2):158–163. https://doi.org/10.1111/j.1341-8076.2005.00264.x

    Article  PubMed  Google Scholar 

  11. Klingele CJ, Bharucha AE, Fletcher JG, Gebhart JB, Riederer SG, Zinsmeister AR (2005) Pelvic organ prolapse in defecatory disorders. Obstet Gynecol 106(2):315–320. https://doi.org/10.1097/01.AOG.0000171104.72972.34

    Article  PubMed  Google Scholar 

  12. Kulaksizoglu H, Toktas G, Kulaksizoglu IB, Aglamis E, Unluer E (2002) When should quality of life be measured after radical cystectomy? Eur Urol 42(4):350–355

    Article  PubMed  Google Scholar 

  13. Lipshutz B (1918) A composite study of the hypogastric artery and its branches. Annals of surgery 67(5):584–608

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Malavaud B, Vaessen C, Mouzin M, Rischmann P, Sarramon J, Schulman C (2001) Complications for radical cystectomy. Impact of the American Society of Anesthesiologists score. Eur Urol 39(1):79–84. (doi:52416)

    Article  PubMed  CAS  Google Scholar 

  15. McGuire MS, Grimaldi G, Grotas J, Russo P (2000) The type of urinary diversion after radical cystectomy significantly impacts on the patient’s quality of life. Ann Surg Oncol 7(1):4–8

    Article  PubMed  CAS  Google Scholar 

  16. Mischinger J, Abdelhafez MF, Todenhofer T, Schwentner C, Aufderklamm S, Stenzl A, Gakis G (2015) Quality of life outcomes after radical cystectomy: long-term standardized assessment of Studer Pouch versus I-Pouch. World J Urol 33(10):1381–1387. https://doi.org/10.1007/s00345-014-1461-8

    Article  PubMed  Google Scholar 

  17. Mottrie A, Buffi N, Lughezzani G, Denaeyer G, Schatteman P, Carpentier P, Fonteyne E (2009) Female robotic radical cystectomy. BJU Int 104(7):1024–1035. https://doi.org/10.1111/j.1464-410X.2009.08877.x

    Article  PubMed  Google Scholar 

  18. Zahran MH, Fahmy O, El-Hefnawy AS, Ali-El-Dein B (2016) Female sexual dysfunction post radical cystectomy and urinary diversion. Climacteric 19(6):546–550. https://doi.org/10.1080/13697137.2016.1225714

    Article  PubMed  CAS  Google Scholar 

  19. Zerbib M, Bouchot O, Coloby P (2002) Mortality, morbidity, and functional results of total cystectomy. Prog Urol 12(5):891–911

    PubMed  Google Scholar 

  20. Zerbib M, Slama J, Coloby P, Bouchot O (2002) Total cystectomy: surgical techniques. Prog Urol 12(5):833–856

    PubMed  Google Scholar 

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Acknowledgements

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

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Authors and Affiliations

  1. Department of General and Gynaecological Surgery, Rangueil University Hospital, 1 Av Pr Poulhès, 31059, Toulouse, France

    E. Chantalat & C. Vaysse

  2. Department of Radiology, Rangueil University Hospital, Toulouse, France

    M. C. Delchier

  3. Department of Urological Surgery, Clinique Pasteur, Toulouse, France

    B. Bordier

  4. Department of Urological Surgery, Rangueil University Hospital, Toulouse, France

    X. Game & M. Roumiguié

  5. Department of Neurosurgery, Pierre Paul Riquet University Hospital, Toulouse, France

    P. Chaynes

  6. Department of Orthopedic Surgery, Pierre Paul Riquet University Hospital, Toulouse, France

    E. Cavaignac

  7. Laboratory of Applied Anatomy, Rangueil University Hospital, Toulouse, France

    E. Chantalat, P. Chaynes, E. Cavaignac & M. Roumiguié

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  1. E. Chantalat
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  2. C. Vaysse
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  8. M. Roumiguié
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Correspondence to E. Chantalat.

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Chantalat, E., Vaysse, C., Delchier, M.C. et al. Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women. Surg Radiol Anat 40, 729–734 (2018). https://doi.org/10.1007/s00276-018-2007-3

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  • DOI: https://doi.org/10.1007/s00276-018-2007-3

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