Surgical anatomy of accessory pudendal arteries in Japanese men: preservation techniques for robot-assisted radical prostatectomy

摘要

This study aimed to investigate the anatomy of the accessory pudendal artery (APA) in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy (RARP). APA was defined as “any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum”. The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023, including the number, laterality, side, size, and local distribution (apical vs. lateral). The apical APA emerges near the prostatic apical region, whereas the lateral APA courses along the lateral aspect of the prostate. They are further classified as the prostatic, fascial, and pubic APAs. Our APA identification and preservation techniques were described based on this classification. Of the 589 Japanese men, 299 (51%) men were with one or more APAs: 169 with one APA, 115 with two APAs, 14 with three APAs, and one with four APAs; and a total of 445 APAs were found. Approximately 97% of the APAs (432/445) were preserved. More lateral APAs were found than apical APAs (243/589 [41%] vs. 79/589 [13%]; p <0.001). Lateral APAs had a higher proportion of large-caliber arteries than apical APAs (59/359 [16%] vs. 1/86 [1.2%]; p <0.001), particularly prostatic and fascial APAs (14/59 [24%] and 40/163 [25%], respectively). This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP. Further research is needed to evaluate the clinical benefits of APA preservation.