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Ozawa Y, Aoki K, Koike S, Yamada M, Odagaki Y, Sakamoto H, Yoshioka K. Clinical Anatomy of the Superficial Preprostatic Vein and Accessory Pudendal Artery in Robot-Assisted Radical Prostatectomy. J Endourol 2024; 38:564-572. [PMID: 38545752 DOI: 10.1089/end.2023.0724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Purpose: We herein describe the superficial preprostatic vein (SPV) anatomy and determine its relationship with the accessory pudendal artery (APA). Materials and Methods: We reviewed 500 patients with localized prostate cancer who underwent conventional robot-assisted radical prostatectomy between April 2019 and March 2023 at our institution. SPV was defined as "any vein coming from the space between the puboprostatic ligaments and running within the retropubic adipose tissue anterior to the prostate toward the vesical venous plexus or pelvic side wall." While APA was defined as "any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudal toward the anterior perineum." The intraoperative anatomy of each SPV and APA was described. Results: SPVs had a prevalence rate of 88%. They were preserved in 252 men (58%) and classified as I-, reversed-Y (rY)-, Y-, or H-shaped (64%, 22%, 12%, and 2%, respectively) based on their intraoperative appearance. Overall, 214 APAs were found in 142 of the 252 men with preserved SPV (56%; 165 lateral and 50 apical APAs in 111 and 41 men, respectively). SPVs were pulsatile in 39% men perhaps due to an accompanying tiny artery functioning as a median APA. Pulsations seemed to be initially absent in most SPVs but become apparent late during surgery possibly due to increased arterial and venous blood flow after prostate removal. Pulsations were common in men with ≥1 APA. Conclusions: This study, which described the anatomical variations in arteries and veins around the prostrate and their preservation techniques, revealed that preserving this vasculature may help preserve postprostatectomy erection. ClinicalTrials: The Clinical Research Registration Number is 230523D.
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Affiliation(s)
- Yu Ozawa
- Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Keisuke Aoki
- Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Shin Koike
- Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Masumi Yamada
- Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Yu Odagaki
- Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Hideo Sakamoto
- Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan
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Ou YC, Lu CH, Lin YS, Huang LH, Weng WC, Hsu CY, Tung MC. Complications of robotic-assisted laparoscopic radical prostatectomy: Experience Sharing from 2000 cases involving a single surgeon. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_173_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Jomoto W, Tanooka M, Wakayama T, Minamoto T, Suzuki T, Ishikura R, Yamamoto S, Kotoura N. Evaluation of local look diffusion tensor imaging for magnetic resonance tractography of the periprostatic neurovascular bundle. Radiol Phys Technol 2018; 11:353-359. [DOI: 10.1007/s12194-018-0470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/29/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
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Jomoto W, Tanooka M, Doi H, Kikuchi K, Mitsuie C, Yamada Y, Suzuki T, Yamano T, Ishikura R, Kotoura N, Yamamoto S. Development of a Three-dimensional Surgical Navigation System with Magnetic Resonance Angiography and a Three-dimensional Printer for Robot-assisted Radical Prostatectomy. Cureus 2018. [PMID: 29531871 PMCID: PMC5837468 DOI: 10.7759/cureus.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We sought to develop a surgical navigation system using magnetic resonance angiography (MRA) and a three-dimensional (3D) printer for robot-assisted radical prostatectomy (RARP). Six patients with pathologically proven localized prostate cancer were prospectively enrolled in this study. Prostate magnetic resonance imaging (MRI), consisting of T2-weighted sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) and true fast imaging with steady-state precession (true FISP), reconstructed by volume rendering, was followed by dynamic contrast-enhanced MRA performed with a volumetric interpolated breath-hold examination (VIBE) during intravenous bolus injection of gadobutrol. Images of arterial and venous phases were acquired over approximately 210 seconds. Selected images were sent to a workstation for generation of 3D volume-rendered images and standard triangulated language (STL) files for 3D print construction. The neurovascular bundles (NVBs) were found in sequence on non-contrast images. Accessory pudendal arteries (APAs) were found in all cases in the arterial phase of contrast enhancement but were ill-defined on non-contrast enhanced MRA. Dynamic contrast-enhanced MRA helped to detect APAs, suggesting that this 3D system using MRI will be useful in RARP.
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Affiliation(s)
- Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine
| | - Keisuke Kikuchi
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Chiemi Mitsuie
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | - Toru Suzuki
- Department of Urology, Hyogo College of Medicine
| | | | | | - Noriko Kotoura
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
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Henry BM, Pękala PA, Vikse J, Sanna B, Skinningsrud B, Saganiak K, Walocha JA, Tomaszewski KA. Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy. J Urol 2017; 198:345-353. [DOI: 10.1016/j.juro.2017.01.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A. Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Bendik Skinningsrud
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Saganiak
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A. Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Moya C, Cuesta J, Friera A, Gil-Vernet Sedó JM, Valderrama-Canales FJ. Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy. Clin Anat 2016; 30:71-80. [DOI: 10.1002/ca.22746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/10/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Celia Moya
- Department of Human Anatomy and Embryology Faculty of Medicine; Complutense University of Madrid; Madrid Spain
| | - Julián Cuesta
- Vascular and Interventional Radiology Unit; Radiology Service, Hospital Universitario De La Princesa; Madrid Spain
| | - Alfonsina Friera
- Vascular and Interventional Radiology Unit; Radiology Service, Hospital Universitario De La Princesa; Madrid Spain
| | | | - Francisco J. Valderrama-Canales
- Department of Human Anatomy and Embryology Faculty of Medicine; Complutense University of Madrid; Madrid Spain
- Corpses Donation Centre; Complutense University of Madrid; Spain
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Salonia A, Castagna G, Capogrosso P, Castiglione F, Briganti A, Montorsi F. Prevention and management of post prostatectomy erectile dysfunction. Transl Androl Urol 2016; 4:421-37. [PMID: 26816841 PMCID: PMC4708594 DOI: 10.3978/j.issn.2223-4683.2013.09.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between “back to baseline” EF and “erections adequate enough to have successful intercourse” clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also extensively discussed. Optimal outcomes are achieved mainly by the careful choice of the correct patient for the correct type of surgery. Despite a plethora of potential rehabilitative approaches, they should be only considered as “strategies”, since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED.
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Affiliation(s)
- Andrea Salonia
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Giulia Castagna
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Paolo Capogrosso
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Fabio Castiglione
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Alberto Briganti
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Francesco Montorsi
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
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Thai CT, Karam IM, Nguyen-Thi PL, Lefèvre F, Hubert J, Felblinger J, Eschwège P. Pelvic magnetic resonance imaging angioanatomy of the arterial blood supply to the penis in suspected prostate cancer patients. Eur J Radiol 2015; 84:823-7. [PMID: 25701410 DOI: 10.1016/j.ejrad.2015.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the internal pudendal artery (IPA) and accessory pudendal artery (APA) detected by magnetic resonance (MR) angiography to help surgeons to find and preserve them during radical prostatectomy (RP). MATERIALS AND METHODS Constrast-enhanced MR 3.0 T angiography of the pelvis were performed in 111 male patients suspected diagnosis of prostate cancer (PCa), and describe the penile arterial blood supply. RESULTS There are three patterns of the arterial blood supply to the penis (IPA and/or APA) accounting for 51.4%, 46.8% and 1.8% of cases, respectively. About the accessory pudendal artery (APA): 54/111 (48.6%) patients had APA with five different branching patterns, they were type I (APA bilateral symmetry): 17 (31.5%); type II (APA bilateral asymmetry): 1 (1.9%); type III (APA unilateral lateral): 13 (24%); type IV (APA unilateral apical): 21 (38.9%); type V (APA unilateral mix): 2 (3.7%). APA origin were from inferior epigastric artery (IEA): 7 (9.5%); from inferior vesical artery (IVA): 32 (43.2%); from obturator artery (OA): 35 (47.3%). CONCLUSION A precise angioanatomic evalutation of arteries destined to the penis by MR angiography pre-operation for male pelvic organs will help surgeons to preserve them and contributes to reduce the erectile dysfunction after these procedures.
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Affiliation(s)
- Cao Tan Thai
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex, France; IADI Laboratory, INSERM-U947, Brabois Hospital, University Hospital of Nancy, Tour Drouet, rue du Morvan, 54511 Vandoeuvre Lès Nancy Cedex, France.
| | - Ibrahim Michel Karam
- Clinical Epidemiology and Evaluation Department, University Hospital of Nancy, France; Department of Anatomy, Faculty of Medicine Nancy, 9 Avenue de la Foret de haye BP, 54505 Vandoeuvre Lès Nancy Cedex, France
| | - Phi Linh Nguyen-Thi
- Clinical Epidemiology and Evaluation Department, University Hospital of Nancy, France; INSERM, CIC-EC CIE6, 92 Avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Frédéric Lefèvre
- Department of Radiology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex, France
| | - Jacques Hubert
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex, France; IADI Laboratory, INSERM-U947, Brabois Hospital, University Hospital of Nancy, Tour Drouet, rue du Morvan, 54511 Vandoeuvre Lès Nancy Cedex, France
| | - Jacques Felblinger
- IADI Laboratory, INSERM-U947, Brabois Hospital, University Hospital of Nancy, Tour Drouet, rue du Morvan, 54511 Vandoeuvre Lès Nancy Cedex, France
| | - Pascal Eschwège
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex, France
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