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The incidence and anatomy of accessory pudendal arteries as depicted on multidetector-row CT angiography: clinical implications of preoperative evaluation for laparoscopic and robot-assisted radical prostatectomy.

Park BJ, Sung DJ, Kim MJ, Cho SB, Kim YH, Chung KB, Kang SH, Cheon J - Korean J Radiol (2009 Nov-Dec)

Bottom Line: All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery.The majority of apical APAs arose from the internal obturator artery (84%).Seven patients (19%) had multiple APAs.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Anam Hospital, Korea University, College of Medicine, Korea.

ABSTRACT

Objective: To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description.

Materials and methods: The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64-channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus.

Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs.

Conclusion: APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy.

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Three-dimensional postprocessing images of accessory pudendal arteries (arrows) are shown.A-D. Semi-automatic vessel segmentation of accessory pudendal artery (A), Automatic curved multiplanar reformation image (B), maximum-intensity-projection reconstruction image (C) and volume rendering image (D) are shown.
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Figure 1: Three-dimensional postprocessing images of accessory pudendal arteries (arrows) are shown.A-D. Semi-automatic vessel segmentation of accessory pudendal artery (A), Automatic curved multiplanar reformation image (B), maximum-intensity-projection reconstruction image (C) and volume rendering image (D) are shown.

Mentions: An APA was defined as any artery located within the periprostatic region running parallel to the dorsal vascular complex. The cavernous arteries, corona mortis and satellite arteries of the superficial and deep vascular complex were excluded from this definition. Two distinct varieties were subdivided as follows. 1) Lateral APAs were defined as coursing along the lateral aspect of the prostate and in intimate contact with the prostatic surface. 2) Apical APAs were defined as emerging near the anterolateral region of the prostatic apex close to the pubic bone. A retrospective review of all MDCT angiography source data was performed by consensus between two of the investigators (with 13 and seven years of board-certificated clinical experience in genitourinary and gastrointestinal radiology, respectively) as to the course, number and origin of the APAs. MDCT axial source images were evaluated and were used to evaluate the anatomy of the APAs. Some axial source images were processed on an Aquaris Workstation version 3.5.0.3 (TeraRecon, San Mateo, CA). During three-dimensional (3D) post processing, APAs were segmented by selection (clicking on the depictions with the computer mouse) and the segmented vessels were extended by dragging on the endpoints. Segmentation facilitated additional evaluation of the APAs, as it resulted in automatically generated curved multiplanar reformation images (Fig. 1).


The incidence and anatomy of accessory pudendal arteries as depicted on multidetector-row CT angiography: clinical implications of preoperative evaluation for laparoscopic and robot-assisted radical prostatectomy.

Park BJ, Sung DJ, Kim MJ, Cho SB, Kim YH, Chung KB, Kang SH, Cheon J - Korean J Radiol (2009 Nov-Dec)

Three-dimensional postprocessing images of accessory pudendal arteries (arrows) are shown.A-D. Semi-automatic vessel segmentation of accessory pudendal artery (A), Automatic curved multiplanar reformation image (B), maximum-intensity-projection reconstruction image (C) and volume rendering image (D) are shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2770828&req=5

Figure 1: Three-dimensional postprocessing images of accessory pudendal arteries (arrows) are shown.A-D. Semi-automatic vessel segmentation of accessory pudendal artery (A), Automatic curved multiplanar reformation image (B), maximum-intensity-projection reconstruction image (C) and volume rendering image (D) are shown.
Mentions: An APA was defined as any artery located within the periprostatic region running parallel to the dorsal vascular complex. The cavernous arteries, corona mortis and satellite arteries of the superficial and deep vascular complex were excluded from this definition. Two distinct varieties were subdivided as follows. 1) Lateral APAs were defined as coursing along the lateral aspect of the prostate and in intimate contact with the prostatic surface. 2) Apical APAs were defined as emerging near the anterolateral region of the prostatic apex close to the pubic bone. A retrospective review of all MDCT angiography source data was performed by consensus between two of the investigators (with 13 and seven years of board-certificated clinical experience in genitourinary and gastrointestinal radiology, respectively) as to the course, number and origin of the APAs. MDCT axial source images were evaluated and were used to evaluate the anatomy of the APAs. Some axial source images were processed on an Aquaris Workstation version 3.5.0.3 (TeraRecon, San Mateo, CA). During three-dimensional (3D) post processing, APAs were segmented by selection (clicking on the depictions with the computer mouse) and the segmented vessels were extended by dragging on the endpoints. Segmentation facilitated additional evaluation of the APAs, as it resulted in automatically generated curved multiplanar reformation images (Fig. 1).

Bottom Line: All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery.The majority of apical APAs arose from the internal obturator artery (84%).Seven patients (19%) had multiple APAs.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Anam Hospital, Korea University, College of Medicine, Korea.

ABSTRACT

Objective: To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description.

Materials and methods: The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64-channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus.

Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs.

Conclusion: APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy.

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