22 Neurovasculature

Arteries & Veins of the Pelvis

Table 22.1 Branches of the arteria iliaca interna

The a. iliaca interna gives off five parietal (pelvic wall) and four visceral (pelvic organs) branches.* Parietal branches are shown in italics.
Branches
	A. iliolumbalis
	A. glutea superior
	Aa. sacrales laterales
	A. umbilicalis	A. ductus deferentis
		Aa. vesicales superiores
	A. obturatoria
	A. vesicalis inferior
	A. rectalis media
	A. pudenda interna	A. rectalis inferior
		A. dorsalis penis
		Rr. scrotales posteriores
	A. glutea inferior
* In the female pelvis, the aa. uterina and vaginalis arise directly from the anterior division of the a. iliaca interna.

Table 22.2 Venous drainage of the pelvis

Tributaries
	Vv. gluteae superiores
	Vv. sacrales laterales
	Vv. obturatoriae
	Vv. vesicales
	Plexus venosus vesicalis
	Vv. rectales mediae (plexus venosus rectalis) (also vv. rectales superiores and inferiores, not shown)
	V. pudenda interna
	Vv. gluteae inferiores
	Plexus venosus prostaticus
	Plexus venosi uterinus and vaginalis
The male pelvis also contains veins draining the penis and scrotum.

Fig. 22.1 Blood vessels of the pelvis
Idealized right hemipelvis, left lateral view.

Arteries & Veins of the Rectum & Genitalia

Fig. 22.2 Blood vessels of the rectum
A posterior view. The main blood supply to the rectum is from the aa. rectales superiores; the aa. rectales mediae serve as an anastomosis between the aa. rectales superior and inferior.

Fig. 22.3 Arterial supply of the cavernous body of the rectum (hemorrhoidal plexus)
Caudal view with patient in lithotomy position. The hemorrhoidal plexus is a permanently distended cavernous body. It's supplied by three branches of the a. rectalis superior at the 3, 7, and 11 o'clock positions where they form three major cushions and four minor cushions in the area of the columnae anales. These circular cavernous structures filled with blood serve as an effective continence mechanism that ensures liquid- and gas-tight closure. The sustained contraction of the muscular sphincter apparatus inhibits venous drainage, and blood is allowed to drain from the cavernous body when the sphincters relax during defecation.

Fig. 22.4 Blood vessels of the genitalia
Anterior view.

Nodi Lymphoidei of the Abdomen & Pelvis

Fig. 22.5 Lymphatic drainage of the internal organs
Lymph draining from the abdomen, pelvis, and lower limb ultimately passes through the nll. lumbales sinistri and dextri. (See Table 22.3 for numbering.) The nll. lumbales consist of the nll. cavales and aortici laterales, the nll. preaortici, and the nll. retroaortici/retrocavales. Effer ent lymph vessels from the nll. aortici and cavales laterales and the nll. retroaortici and retrocavales form the trunci lumbales and those from the nll. preaortici form the trunci intestinales. The trunci lumbales and intestinales terminate in the cisterna chyli.

Table 22.3 Nodi lymphoidei of the abdomen

Nll. phrenici inferiores
Nll. lumbales	Nll. preaortici	Nll. coeliaci
		Nll. mesenterici superiores
		Nll. mesenterici inferiores
	Nll. aortici laterales
	Nll. cavales laterales
	Nll. retroaortici (retrocavales)
Nll. iliaci communes

Fig. 22.6 Lymphatic drainage of the rectum
Anterior view.

Fig. 22.7 Lymphatic drainage of the vesica urinaria and urethra
Anterior view.

Fig. 22.8 Lymphatic drainage of the male genitalia
Anterior view.

Fig. 22.9 Lymphatic drainage of the female genitalia
Anterior view.

Table 22.4 Nodi lymphoidei of the pelvis

Numbers continued from Table 22.3.
Nll. preaortici	Nll. mesenterici superiores
	Nll. mesenterici inferiores
Nll. aortici laterales
Nll. cavales laterales
Nll. iliaci communes
Nll. iliaci interni
Nll. iliaci externi
Nll. inguinales superficiales	Horizontal group
	Vertical group
Nll. inguinales profundi
Nll. sacrales

Nodi Lymphoidei of the Genitalia

Fig. 22.10 Nodi lymphoidei of the male genitalia
Anterior view. Removed: Gastrointestinal tract (except rectal stump) and peritoneum.

Fig. 22.11 Nodi lymphoidei of the female genitalia
Anterior view. Removed: Gastrointestinal tract (except rectal stump) and peritoneum. Retracted: Uterus.

Fig. 22.12 Lymphatic drainage of the pelvic organs

Autonomic Plexuses of the Pelvis

Fig. 22.13 Autonomic plexuses in the pelvis
Anterior view of the male lower abdomen. Removed: Peritoneum and abdominopelvic organs except renes.

Fig. 22.14 Innervation of the urinary organs
Anterior view of the male lower abdomen and pelvis. Removed: Peritoneum and abdominopelvic organs except renes, gll. suprarenales, rectal stump, and vesica urinaria. See p. 276 for schematic of innervation of urinary organs.

Fig. 22.15 Innervation of the female pelvis
Right pelvis, left lateral view. Reflected: Uterus and rectum. See p. 277 for schematic of innervation of genitalia.

Fig. 22.16 Innervation of the male pelvis
Right pelvis, left lateral view. See p. 277 for schematic of innervation of genitalia.

Autonomic Innervation: Urinary & Genital Organs & Rectum

Fig. 22.17 Autonomic innervation of the urinary organs

Clinical box 22.1

Referred pain from the internal organs
The convergence of somatic and visceral neurofibrae afferentes to a common actual sites of pain, a phenomenon known as referred pain. Pain impulses from a particular organ are consistently projected to the same well-defined skin area.

Fig. 22.18 Autonomic innervation of the genitalia

Fig. 22.19 Innervation of the rectum
Left side of image shows somatic nerves (nn. spinales); right side of image shows nn. autonomici.

Neurovasculature of the Female Perineum & Genitalia

Fig. 22.20 Nerves of the female perineum and genitalia

Fig. 22.21 Blood vessels of the female external genitalia
Inferior view.

Fig. 22.22 Neurovasculature of the female perineum
Lithotomy position. Removed from left side: Mm. bulbospongiosus and ischiocavernosus.

Neurovasculature of the Male Perineum & Genitalia

Fig. 22.23 Neurovasculature of the male genitalia
Left lateral view.

Fig. 22.24 Neurovasculature of the penis and scrotum

Fig. 22.25 Nerves of the male perineum and genitalia
Lithotomy position.

Fig. 22.26 Neurovasculature of the male perineum
Lithotomy position. Removed from left side: Membrana perinei, m. bulbospongiosus, and radix penis.