Clinical Anatomy of the Superficial Preprostatic Vein and Accessory Pudendal Artery in Robot-Assisted Radical Prostatectomy.

Abstract

We reviewed 500 patients with localized prostate cancer who underwent conventional robot-assisted radical prostatectomy between April 2019 and March 2023 at our institution. Superficial preprostatic vein 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 accessory pudendal artery 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 superficial preprostatic vein and accessory pudendal artery was described. Superficial preprostatic veins had a prevalence rate of 88%. They were preserved in 252 men (58%) and classified as I-, rY-, Y-, or H-shaped (64%, 22%, 12%, and 2%, respectively) based on their intraoperative appearance. Overall, 214 accessory pudendal arteries were found in 142 of the 252 men with preserved superficial preprostatic vein (56%) (165 lateral and 50 apical accessory pudendal arteries in 111 and 41 men, respectively). Superficial preprostatic veins were pulsatile in 39% men perhaps due to an accompanying tiny artery functioning as a median accessory pudendal artery. Pulsations seemed to be initially absent in most superficial preprostatic veins 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 accessory pudendal artery. 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 post-prostatectomy erection.