Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy

Henry, Brandon Michael; Pękala, Przemysław A.; Vikse, Jens; Sanna, Beatrice; Skinningsrud, Bendik; Saganiak, Karolina; Walocha, Jerzy; Tomaszewski, Krzysztof A.

doi:10.1016/j.juro.2017.01.080

Cited by 25 publications

(22 citation statements)

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“…The APA is defined as any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudal toward the anterior perineum. A recent meta-analysis, [ 28 ] evaluating 23 studies, reported that the APA was present in 28.5% of patients. When present, unilateral accessory pudendal arteries were most common (pooled prevalence estimate 72.5%), or they were present on the right or the left side (pooled prevalence estimate 48.0 or 52.0%, respectively).…”

Section: Prostate Arterial Supply: Artery-sparing Surgery Myth or Reamentioning

confidence: 99%

Surgical Techniques for Managing Post-prostatectomy Erectile Dysfunction

2017

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Purpose of ReviewDue to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative erectile dysfunction (ED). The aim of this study is to summarize the current literature on surgical techniques for managing post-prostatectomy erectile dysfunction.Recent FindingsThe PubMed database was searched for English-language articles published up to Jan 2017 using the following search terms: “prostatectomy AND erectile dysfunction”, “prostatectomy AND penile prostheses”, and “prostatectomy AND penile implants”. All of the studies that evaluated medical treatment were excluded. In the last few decades, the understanding of the anatomy of the male pelvis and prostate has improved. This has led to significant changes in the nerve-sparing radical prostatectomy techniques, with the aim of preserving post-surgical erectile function (EF). In this scenario, the prostate vascular supply and the anatomy of the neurovascular bundles have a central role. Penile prosthesis implantation is considered the third-line treatment option for RP ED patients, and they have been reported to be a very successful treatment with the highest patient satisfaction rate.SummaryConsidering the failure of penile rehabilitation, and the lack of evidence for accessory pudendal artery (APA) preservation and nerve graft, nerve-sparing surgery and penile prostheses represent, today, the only methods to permanently and definitively preserve or erectile function after RP.

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Section: Prostate Arterial Supply: Artery-sparing Surgery Myth or Reamentioning

confidence: 99%

Surgical Techniques for Managing Post-prostatectomy Erectile Dysfunction

2017

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“…The proportion of men with APAs varies according to the method used to detect them. Incidence has ranged from 4%–75% in radiological and pathological studies [ 6 , 13 - 18 ]. In a retrospective clinical study, Park, et al suggested a possible connection between APA preservation and postsurgical functional outcome [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…First, we can’t identify APAs intraoperatively. Since 60% of APAs are the apical type, it is often impossible to confirm APAs during surgery [ 18 ]. However, we believe that tracing of APAs by MRI and 3D modeling is likely to provide more accurate information about the incidence and anatomical associations of APAs.…”

Section: Discussionmentioning

confidence: 99%

Development of a Three-dimensional Surgical Navigation System with Magnetic Resonance Angiography and a Three-dimensional Printer for Robot-assisted Radical Prostatectomy

Jomoto¹,

Tanooka²,

Doi³

et al. 2018

Cureus

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We sought to develop a surgical navigation system using magnetic resonance angiography (MRA) and a three-dimensional (3D) printer for robot-assisted radical prostatectomy (RARP). Six patients with pathologically proven localized prostate cancer were prospectively enrolled in this study. Prostate magnetic resonance imaging (MRI), consisting of T2-weighted sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) and true fast imaging with steady-state precession (true FISP), reconstructed by volume rendering, was followed by dynamic contrast-enhanced MRA performed with a volumetric interpolated breath-hold examination (VIBE) during intravenous bolus injection of gadobutrol. Images of arterial and venous phases were acquired over approximately 210 seconds. Selected images were sent to a workstation for generation of 3D volume-rendered images and standard triangulated language (STL) files for 3D print construction. The neurovascular bundles (NVBs) were found in sequence on non-contrast images. Accessory pudendal arteries (APAs) were found in all cases in the arterial phase of contrast enhancement but were ill-defined on non-contrast enhanced MRA. Dynamic contrast-enhanced MRA helped to detect APAs, suggesting that this 3D system using MRI will be useful in RARP.

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“…In 2017, a meta-analysis by Henry and colleagues introduced two potential issues. 20 First, they recommend preservation of the APA in 5.4% of men with penile blood supplied solely by an APA-an observation based on a cadaveric study by Droupy and colleagues in 1996. 21 It is important to recognize that the presence or absence of internal pudendal arteries (IPA) cannot be determined because these arteries course outside of the levator ani.…”

Section: Discussionmentioning

confidence: 99%