Analysis of Accessory Pudendal Artery Transection on Erections During Robot-Assisted Radical Prostatectomy

Williams, Stephen B.; Morales, Blanca; Huynh, Linda; Osann, Kathryn; Skarecky, Douglas; Ahlering, Thomas E.

doi:10.1089/end.2017.0542

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…Our surgical technique regarding accessory pudendal arteries (APAs) was recently published. 6 While surgical preservation of APAs is optimal, we presented data from a robust patient cohort that sacrifice of APA(s) during RARP did not lessen recovery of erectile function. We found no evidence that transecting one or more APA(s) reduced recovery of erections or potency in normal baseline function of men.…”

Section: Postoperative Carementioning

confidence: 95%

Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide

Huynh

Ahlering

2018

Journal of Endourology

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Radical prostatectomy remains an important means to treat prostate cancer. A major limiting factor to radical prostatectomy is short- and long-term complications, especially incontinence and sexual dysfunction. With the advent of robotic radical prostatectomy, the ability to easily evaluate technical issues with video has been realized. In this article, we present a step-by-step examination of our procedure and our results over the past 5 years.

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Section: Postoperative Carementioning

confidence: 95%

Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide

Huynh

Ahlering

2018

Journal of Endourology

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“…Previous studies have confirmed that NVB preservation reduces the incidence of postoperative erectile dysfunction and urinary incontinence (9,18). However, even with preservation of the NVBs, accessory pudendal artery or other structures, and the postoperative use of drugs, such as statins, erectile dysfunction appeared to be uncontrollable (7,18,19). Thus, all the patients enrolled in this study had erectile dysfunction and a lack of desire to engage in sexual activity.…”

Section: Discussionmentioning

confidence: 55%

Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study

Zhou¹,

Xu²,

Shuan³

et al. 2023

Transl Androl Urol

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Background: Suspected localized prostate cancer (PCa) patients with dysuria Complete intrafascial prostatectomy (CIP) can remove the whole prostate gland with the maximal retain of adjacent normal tissues around the prostate, and can be applied in some suspected localized prostate cancer (PCa) patients with dysuria. However, precious few studies have assessed the efficacy and safety of CIP in these patients without preoperative needle biopsies. Methods:In this retrospective single-arm cohort study, all 22 suspected PCa patients with dysuria who underwent CIP at our hospital were enrolled. The clinical data including age, prostate-specific antigen (PSA), free-serum PSA, prostate volume, perioperative and postoperative complications were collected. The PSA level at 6 weeks after CIP and recoveries of urinary continence and erectile function were acquired in the follow-up procedures, and were used as the main measurements of efficacy and safety for CIP respectively. Results:The patients had an average age of 71.91±8.29 years and an average preoperative PSA level of 10.75±4.25 ng/mL. The operations for all 22 patients were successfully completed. The average operation time was 135.20±41.44 min (range, 40.0-215.0 min), and the average blood loss volume was 128.64±145.09 mL. In total, 17 patients (77.27%) had PCa confirmed by postoperative pathology, and 5 patients (22.73%) had benign prostatic hyperplasia. The PSA level dropped to 0.010±0.004 ng/mL at 6 weeks after surgery. According to the loose criteria to assess urinary incontinence, the patients achieved continence rates of 63.6% immediately after the operation, 95.5% at 1 month, and 100% at 3 months. According to the strict criteria, the continence rates immediately, and at 1, 3, 6, and 9 months after surgery were 27.3%, 63.6%, 90.9%, 95.5%, and 100%, respectively. None of the patients complained of urinary obstruction symptoms after surgery. Before CIP, all the patients had erectile dysfunction and an International Index of Erectile Function 5 (IIEF-5) score of 9.64±5.91.After surgery, the patients had IIEF-5 scores at 3, 6, and 12 months of 5.45±4.43, 6.95±5.30, and 7.57±5.69, respectively.Conclusions: Although the study had some limitations, CIP may be a prudent option for patients with suspected localized PCa who also present with dysuria.

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“…It is of note that there is considerable inter- and intraindividual variability in the vascular anatomy of male patients, such as the occurrence of an accessory or aberrant pudendal arteries (4–75%) ( 68 , 69 ). In a case series with 880 patients who underwent RALP, conducted by Williams et al transection of accessory pudendal arteries did not turn out to be an independent prognostic factor for postoperative erectile dysfunction ( 70 ). Nevertheless, current literature is in agreement that penile blood supply can at least partly originate from accessory pudendal arteries, and thus, attempts to the preservation of these vessels should be performed during radical prostatectomy ( 70 , 71 ).…”

Section: Resultsmentioning

confidence: 99%

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

et al. 2022

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ContextMeticulous knowledge about the anatomy of the prostate and surrounding tissue represents a crucial and mandatory requirement during radical prostatectomy for reliable oncological and excellent replicable, functional outcomes. Since its introduction two decades ago, robotic-assisted laparoscopic radical prostatectomy (RALP) has evolved to become the predominant surgical approach in many industrialized countries.ObjectiveTo provide and highlight currently available literature regarding prostate anatomy and to help in improving oncological and functional outcomes in RALP.Methods/Evidence AcquiringPubMed database was searched using the following keywords: “robotic-assisted radical prostatectomy,” “anatomy,” “neurovascular bundle,” “nerve,” “periprostatic fascia,” “pelvis,” “sphincter,” “urethra,” “urinary incontinence,” and “erectile dysfunction.” Relevant articles and book chapters were critically reviewed and if eligible, they were included in this review.ResultsNew evidence in regards to prostatic anatomy and surgical approaches in RALP has been reported in recent years. Besides detailed anatomical studies investigating the meticulous structure of the fascial structures surrounding the prostate and neurovascular bundle preservation, debate about the optimal RALP approach is still ongoing, inspired by recent publications presenting promising functional outcomes following modifications in surgical approaches.ConclusionsThis review provides a detailed overview of the current knowledge of prostate anatomy, its surrounding tissue, and its influence on key surgical step development for RALP.

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Analysis of Accessory Pudendal Artery Transection on Erections During Robot-Assisted Radical Prostatectomy

Abstract: Good surgical technique dictates the preservation of APAs. However, when preservation is questioned, we found that APA transection had no measurable effect on recovery of erections or potency regardless of age, preoperative ED, or number of APAs transected.

Cited by 6 publications

References 28 publications

Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide

Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide

Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

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