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.
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.


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.


CONCLUSIONS
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.
Park
Beom Jin
BJ
Department of Radiology, Anam Hospital, Korea University, College of Medicine, Korea.
Sung
Deuk Jae
DJ
Kim
Min Ju
MJ
Cho
Sung Bum
SB
Kim
Yun Hwan
YH
Chung
Kyoo Byung
KB
Kang
Seok Ho
SH
Cheon
Jun
J
D000368:Aged; D000792:Angiography / Q000379:methods*; D001158:Arteries / Q000002:abnormalities*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000098:blood supply*; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D014057:Tomography, X-Ray Computed / Q000379:methods*