Korean J Radiol.  2009 Dec;10(6):587-595. 10.3348/kjr.2009.10.6.587.

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

• KMID: 1102562
• DOI: http://doi.org/10.3348/kjr.2009.10.6.587

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.

Keyword

Accessory pudendal arteries; Computed tomography (CT); Angiography; Laparoscopy; Prostatectomy

MeSH Terms

Aged
Angiography/*methods
Arteries/*abnormalities
Humans
Incidence
Laparoscopy
Male
Middle Aged
Prostate/*blood supply
Prostatectomy/*methods
Retrospective Studies
Robotics
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 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.

• 

  Fig. 2 Imaging findings are shown for 69-year-old male with lateral accessory pudendal artery arising from inferior vesical artery. Maximum-intensity-projection reconstruction images (A-F) show right lateral accessory pudendal artery (arrows) coursing along lateral aspect of prostate, which originates from left inferior vesical artery (arrowhead, bottom right).

• 

  Fig. 3 Imaging findings are shown for 69-year-old male with lateral accessory pudendal artery arising from inferior vesical artery. Right lateral accessory pudendal artery (arrows) with proximal portion of bilateral internal pudendal artery (arrowheads) on transparent surrounding anatomy is readily recognized over right pelvic side wall on 3D postprocessing images (A-D) (top, anteroposterior and right anterooblique view; bottom, craniocaudal view).

• 

  Fig. 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).

• 

  Fig. 5 Imaging findings are shown for 56-year-old male with apical accessory pudendal artery arising from internal obturator artery. Maximum-intensity-projection reconstruction images (A-D) show right apical accessory pudendal artery (arrows) that arose from right internal pudendal artery (arrowhead, bottom right) with hairpin turn at dorsal vascular complex (top left).

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