Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy

ObjectivesTo determine the incidence of, and ability to preserve, accessory pudendal arteries (APAs) in patients undergoing laparoscopic radical prostatectomy (LRP). The incidence of APAs is not well established. Preservation of APAs may be important for the maintenance of erectile function after prostatectomy. Data are limited regarding the ability to preserve APAs during laparoscopic surgery.MethodsAt the beginning of each of 70 consecutive laparoscopic radical prostatectomies performed at my institution, a purposeful search for APAs was performed during dissection of the space of Retzius. The operative findings were systematically dictated, and video documentation was obtained whenever possible. In every case in which APAs were identified, an attempt was made to spare them.ResultsOf the 70 patients, 18 (25.7%) were identified as having 23 APAs on the left (n = 8), right (n = 5), or both (n = 5) sides. Documentation and the technique of preservation are detailed in the accompanying video. In all but 1 case, APAs were identified at the initial exploration. APAs were preserved in 78.3% of cases. Of 10 preoperatively potent, sexually active men undergoing bilateral nerve-sparing surgery, all had preservation of APAs.ConclusionsThe incidence of APAs in this consecutive series of LRP was 25.7%. Preservation of the APAs was successful in 78.3% of those with APAs found. Although occasionally the anatomy may not permit vascular preservation, vigilant examination and strategic laparoscopic dissection allow APAs to be successfully spared in most cases.