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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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Imaging findings are shown for 69-year-old male with apical accessory pudendal artery from inferior vesical artery. Maximum-intensity-projection reconstruction images (A-F) show right apical accessory pudendal artery (arrows) emerging near apical region of prostate, which originates from right inferior vesical artery (arrowhead, bottom right) with hairpin turn at dorsal vascular complex (top left).
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Figure 4: Imaging findings are shown for 69-year-old male with apical accessory pudendal artery from inferior vesical artery. Maximum-intensity-projection reconstruction images (A-F) show right apical accessory pudendal artery (arrows) emerging near apical region of prostate, which originates from right inferior vesical artery (arrowhead, bottom right) with hairpin turn at dorsal vascular complex (top left).

Mentions: A total of 44 APAs were identified in 36 of 121 consecutive patients (30%). The APAs were on the right side in 23 (52%) patients and on the left side in 21 (48%) patients. All APAs were subclassified as lateral (Figs. 2, 3) and apical type APAs (Fig. 4): 11 lateral and 33 apical APAs were observed in nine and 29 patients, respectively. Among these APAs, multiple APAs were identified in seven patients (19%). Bilateral same APAs (bilateral lateral APAs in two patients and bilateral apical APAs in three patients) were present in five of 38 patients (14%). Bilateral different APAs were present in one patient (right, apical and left, lateral; 3%) and one patient had three different APAs (right, lateral and apical and left, apical; 3%) (Table 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)

Imaging findings are shown for 69-year-old male with apical accessory pudendal artery from inferior vesical artery. Maximum-intensity-projection reconstruction images (A-F) show right apical accessory pudendal artery (arrows) emerging near apical region of prostate, which originates from right inferior vesical artery (arrowhead, bottom right) with hairpin turn at dorsal vascular complex (top left).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Imaging findings are shown for 69-year-old male with apical accessory pudendal artery from inferior vesical artery. Maximum-intensity-projection reconstruction images (A-F) show right apical accessory pudendal artery (arrows) emerging near apical region of prostate, which originates from right inferior vesical artery (arrowhead, bottom right) with hairpin turn at dorsal vascular complex (top left).
Mentions: A total of 44 APAs were identified in 36 of 121 consecutive patients (30%). The APAs were on the right side in 23 (52%) patients and on the left side in 21 (48%) patients. All APAs were subclassified as lateral (Figs. 2, 3) and apical type APAs (Fig. 4): 11 lateral and 33 apical APAs were observed in nine and 29 patients, respectively. Among these APAs, multiple APAs were identified in seven patients (19%). Bilateral same APAs (bilateral lateral APAs in two patients and bilateral apical APAs in three patients) were present in five of 38 patients (14%). Bilateral different APAs were present in one patient (right, apical and left, lateral; 3%) and one patient had three different APAs (right, lateral and apical and left, apical; 3%) (Table 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.

Show MeSH