Anatomy of accessory pudendal arteries in laparoscopic radical prostatectomy.
OBJECTIVE
The incidence of accessory pudendal arteries (APAs) varies from 4% to 70% depending on the means used to identify them. We provide a detailed laparoscopic anatomical description of their appearance, location and identification rate based on our series of radical prostatectomies.


METHODS
The distribution of APAs was prospectively recorded in 285 consecutive patients between October 2002 and November 2004. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex and extending caudal toward the anterior perineum, other than cavernous arteries, corona mortis and satellite arteries to the superficial and deep vascular complex.


RESULTS
We identified 92 APAs in 72 of 285 patients (25%). Two distinct varieties of APAs were identified. In 10% of patients an APA coursed along the lateral aspect of the prostate, termed lateral APA, and in 13% an APA emerged through the levator ani fibers near the apical region of the prostate, termed apical APA. Five patients (1.7%) were found to have apical and lateral APAs.


CONCLUSIONS
APAs are more frequent than previously reported in the surgical literature. To our knowledge apical APAs have never been reported previously. The visualization and accessibility advantages of laparoscopy may account for a higher intraoperative APA identification rate. Their roles in continence and potency remain to be determined.
Secin
Fernando P
FP
Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Karanikolas
Nicholas
N
Touijer
A Karim
AK
Salamanca
Juan I Martinez
JI
Vickers
Andrew J
AJ
Guillonneau
Bertrand
B
D001158:Arteries / Q000002:abnormalities*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*