Pharmacoangiographic Evidence of the Presence and Anatomical Dominance of Accessory Pudendal Artery(s)

PurposePotency preservation is one of the principal concerns surrounding newer developments in the management of organ confined carcinoma prostate. Nerve sparing techniques may not solely preserve erectile function and it is known that vascular factors may be an etiology of the dysfunction. The role of accessory pudendal arteries in the etiology and prevention of erectile dysfunction after radical prostatectomy is at present unclear. We reviewed pudendal angiograms in patients with erectile dysfunction to evaluate the prevalence and importance of these vessels.Materials and MethodsSelective pudendal pharmacoangiograms were obtained in 79 consecutive patients with a history of erectile dysfunction. The aim was to identify accessory pudendal arteries, their origin and their significance relative to all identifiable pudendal arteries and the dorsal penile artery with respect to penile arterial inflow.ResultsAn accessory pudendal artery was identified in 28 (35%) of the patients. The most common origin was the obturator artery. In 15 of the 28 men (54%) in whom an accessory artery was identified it appeared angiographically to be the dominant penile artery. In 3 patients it was apparently the only major arterial inflow to the penis.ConclusionsAccessory pudendal arteries may be identifiable with pharmacoangiograms in approximately a third of all men. Because they may be the dominant source of blood supply to the penis in some cases, their preservation during radical prostatectomy could be critical to erectile function following radical prostatectomy.