Assessment of accessory pudendal arteries and their surgical significance in radical prostatectomy: insights from computed tomography angiography.

BACKGROUND AND AIM: Preserving accessory pudendal arteries (APAs) after radical prostatectomy is crucial for optimal postoperative sexual function. Our study aimed to describe the detailed anatomy of the APA and its anatomical variations using computed tomography angiography (CTA), thereby providing crucial information for surgical planning and potentially improving postoperative outcomes.

MATERIALS AND

METHODS

This retrospective study evaluated the cases of 65 male patients (130 hemipelves) who underwent CTA examination for peripheral vascular disease between January and June 2017. The requirement for informed consent was waived due to the retrospective nature of the study. The mean age of the participants was 52.50 ± 19.09 years (range: 36-84 years). All CTA examinations were performed using 128 multislice CT scanners with patients in the supine position.

RESULTS

Accessory pudendal arteries were detected in 96 (74%) hemipelves. Among in hemipelves, 30 (23%) followed an apical course and 66 (77%) followed an anterolateral course. Of the remaining anterolateral APAs, 18 were left-sided, 26 were right-sided, and 22 were bilateral. Of the apical APAs, 12 were left-sided, 10 were right-sided, and eight were bilateral. Most APAs originated from the inferior vesical artery, followed by the internal obturator artery.

CONCLUSION

Computed tomography angiography represents a useful noninvasive imaging tool for identifying APAs before prostate surgery, aiding preoperative planning and potentially supporting the preservation of postoperative sexual function. The prevalence of APAs detected by CTA was similar to that reported in cadaveric studies and higher than that observed in laparoscopic reports, highlighting the value of CTA in preoperative assessment.