Unit:
ΠΜΣ Χειρουργική ΑνατομίαLibrary of the School of Health Sciences
Author:
Katsimantas Antonios
Supervisors info:
Παναγιώτης Σκανδαλάκης, Καθηγητής, Ιατρική, ΕΚΠΑ
Θεόδωρος Τρουπής, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Βασίλειος Πρωτογέρου, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Χειρουργική ανατομία της στυτικής λειτουργίας. Ο ρόλος της επικουρικής έσω αιδοιϊκής αρτηρίας και η κλινική της σημασία στις επεμβάσεις ριζικής προστατεκτομής.
Translated title:
Surgical anatomy of erectile function. The role of accessory pudendal artery and its clinical impact on radical prostatectomy.
Summary:
Radical prostatectomy has emerged as the most commonly used treatment modality for clinically localized prostate cancer. Despite the progress regarding the knowledge about prostate’s and erectile function’s surgical anatomy, post-prostatectomy erectile dysfunction remains an important issue for more than half of the patients who underwent radical prostatectomy.
Erectile function demands the integrity and cooperation of vascular and neuronal components. Post-prostatectomy erectile dysfunction may result due to neurogenic or vasculogenic causes or due to the combination of them.
Accessory pudendal artery may participate in penile arterial supply and therefore its ligation or injury during radical prostatectomy may influence postoperative erectile function. During the last years, many authors presented their data regarding incidence of accessory pudendal artery in cadaveric, imaging and surgical studies. However, there is great discordance about the incidence of accessory pudendal artery among them.
On the occasion of reading Henry’s et al study titled «Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy» and based on our experience on laparoscopic radical prostatectomy, some important topics are underlined. During laparoscopic radical prostatectomy, it is difficult to locate the origin and course of accessory pudendal artery because of the narrow, supralevator surgical field. Moreover, the penis is on flaccid state during prostatectomy and some accessory pudendal arteries may not be identifiable due to their small caliber, so application of pharmacologically induced erection and Doppler ultrasound intraoperatively may contribute to their identification. In addition, the effect of artery’s preservation on postoperative erectile function could be clarified by comparing pre- and postoperative imaging techniques with the application of pharmacologically induced erection, with intraoperative data and data of pre- and postoperative erectile function, in the same patient.
The term «accessory» or «aberrant» is unfair for an artery with such an important functional role. The incidence of accessory pudendal artery should be defined through extensive and well-organized cadaveric and radiologic studies with pharmacologically induced erection, with the cooperation of experienced surgeons. Finally, the term «artery-sparing» has to be spread among urologists besides the term «nerve-sparing».
Main subject category:
Health Sciences
Keywords:
Erectile function, Erectile dysfunction, Accessory pudendal artery, Prostate cancer, Radical prostatectomy
