Analysis of Accessory Pudendal Artery Transection on Erections during Robot-Assisted Radical Prostatectomy

Stephen Williams, Blanca E. Morales, Linda M. Huynh, Kathryn Osann, Douglas W. Skarecky, Thomas E. Ahlering

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Purpose: To compare the recovery of erections and potency following the transection of accessory pudendal arteries (APAs) in men undergoing robot-assisted radical prostatectomy (RARP) compared with men with normal vascular anatomy. Materials and Methods: A total of 880 consecutive patients who underwent RARP from January 1, 2007 to December 31, 2014 were included with prospectively collected data in cross-sectional analysis. Erectile function (EF) was assessed preoperatively and postoperatively at 3, 6, 12, and 24 months using the International Index of Erectile Function (IIEF)-5, a percent erection fullness compared to preoperative status, and two Expanded Prostate Cancer Index (EPIC) questions: (1) are erections firm enough for penetration and (2) are they satisfactory? Results: Two hundred thirty-one (33.1%) men had APAs transected. There were no significant differences in baseline demographics or clinical characteristics in men with or without APAs transected. Multivariate analyses demonstrated that age (confidence interval [95% CI]: 0.94, 0.99) and baseline IIEF-5 (95% CI: 1.15, 1.26) strongly correlated with recovery of erections and potency. Transection of APAs was not a significant predictor of erectile dysfunction (ED). Conclusion: Good surgical technique dictates the preservation of APAs. However, when preservation is questioned, we found that APA transection had no measurable effect on recovery of erections or potency regardless of age, preoperative ED, or number of APAs transected.

    Original languageEnglish (US)
    Pages (from-to)1170-1175
    Number of pages6
    JournalJournal of Endourology
    Volume31
    Issue number11
    DOIs
    StatePublished - Nov 1 2017

    Fingerprint

    Prostatectomy
    Arteries
    Erectile Dysfunction
    Blood Vessels
    Prostatic Neoplasms
    Anatomy
    Multivariate Analysis
    Cross-Sectional Studies
    Demography
    Confidence Intervals

    Keywords

    • Accessory pudendal artery
    • Postoperative sexual function
    • Prostate cancer
    • Redundant blood supply
    • Robotic prostatectomy

    ASJC Scopus subject areas

    • Urology

    Cite this

    Analysis of Accessory Pudendal Artery Transection on Erections during Robot-Assisted Radical Prostatectomy. / Williams, Stephen; Morales, Blanca E.; Huynh, Linda M.; Osann, Kathryn; Skarecky, Douglas W.; Ahlering, Thomas E.

    In: Journal of Endourology, Vol. 31, No. 11, 01.11.2017, p. 1170-1175.

    Research output: Contribution to journalArticle

    Williams, Stephen ; Morales, Blanca E. ; Huynh, Linda M. ; Osann, Kathryn ; Skarecky, Douglas W. ; Ahlering, Thomas E. / Analysis of Accessory Pudendal Artery Transection on Erections during Robot-Assisted Radical Prostatectomy. In: Journal of Endourology. 2017 ; Vol. 31, No. 11. pp. 1170-1175.
    @article{ff64a1293ed54624ad183e80860ac622,
    title = "Analysis of Accessory Pudendal Artery Transection on Erections during Robot-Assisted Radical Prostatectomy",
    abstract = "Purpose: To compare the recovery of erections and potency following the transection of accessory pudendal arteries (APAs) in men undergoing robot-assisted radical prostatectomy (RARP) compared with men with normal vascular anatomy. Materials and Methods: A total of 880 consecutive patients who underwent RARP from January 1, 2007 to December 31, 2014 were included with prospectively collected data in cross-sectional analysis. Erectile function (EF) was assessed preoperatively and postoperatively at 3, 6, 12, and 24 months using the International Index of Erectile Function (IIEF)-5, a percent erection fullness compared to preoperative status, and two Expanded Prostate Cancer Index (EPIC) questions: (1) are erections firm enough for penetration and (2) are they satisfactory? Results: Two hundred thirty-one (33.1{\%}) men had APAs transected. There were no significant differences in baseline demographics or clinical characteristics in men with or without APAs transected. Multivariate analyses demonstrated that age (confidence interval [95{\%} CI]: 0.94, 0.99) and baseline IIEF-5 (95{\%} CI: 1.15, 1.26) strongly correlated with recovery of erections and potency. Transection of APAs was not a significant predictor of erectile dysfunction (ED). Conclusion: Good surgical technique dictates the preservation of APAs. However, when preservation is questioned, we found that APA transection had no measurable effect on recovery of erections or potency regardless of age, preoperative ED, or number of APAs transected.",
    keywords = "Accessory pudendal artery, Postoperative sexual function, Prostate cancer, Redundant blood supply, Robotic prostatectomy",
    author = "Stephen Williams and Morales, {Blanca E.} and Huynh, {Linda M.} and Kathryn Osann and Skarecky, {Douglas W.} and Ahlering, {Thomas E.}",
    year = "2017",
    month = "11",
    day = "1",
    doi = "10.1089/end.2017.0542",
    language = "English (US)",
    volume = "31",
    pages = "1170--1175",
    journal = "Journal of Endourology",
    issn = "0892-7790",
    publisher = "Mary Ann Liebert Inc.",
    number = "11",

    }

    TY - JOUR

    T1 - Analysis of Accessory Pudendal Artery Transection on Erections during Robot-Assisted Radical Prostatectomy

    AU - Williams, Stephen

    AU - Morales, Blanca E.

    AU - Huynh, Linda M.

    AU - Osann, Kathryn

    AU - Skarecky, Douglas W.

    AU - Ahlering, Thomas E.

    PY - 2017/11/1

    Y1 - 2017/11/1

    N2 - Purpose: To compare the recovery of erections and potency following the transection of accessory pudendal arteries (APAs) in men undergoing robot-assisted radical prostatectomy (RARP) compared with men with normal vascular anatomy. Materials and Methods: A total of 880 consecutive patients who underwent RARP from January 1, 2007 to December 31, 2014 were included with prospectively collected data in cross-sectional analysis. Erectile function (EF) was assessed preoperatively and postoperatively at 3, 6, 12, and 24 months using the International Index of Erectile Function (IIEF)-5, a percent erection fullness compared to preoperative status, and two Expanded Prostate Cancer Index (EPIC) questions: (1) are erections firm enough for penetration and (2) are they satisfactory? Results: Two hundred thirty-one (33.1%) men had APAs transected. There were no significant differences in baseline demographics or clinical characteristics in men with or without APAs transected. Multivariate analyses demonstrated that age (confidence interval [95% CI]: 0.94, 0.99) and baseline IIEF-5 (95% CI: 1.15, 1.26) strongly correlated with recovery of erections and potency. Transection of APAs was not a significant predictor of erectile dysfunction (ED). Conclusion: Good surgical technique dictates the preservation of APAs. However, when preservation is questioned, we found that APA transection had no measurable effect on recovery of erections or potency regardless of age, preoperative ED, or number of APAs transected.

    AB - Purpose: To compare the recovery of erections and potency following the transection of accessory pudendal arteries (APAs) in men undergoing robot-assisted radical prostatectomy (RARP) compared with men with normal vascular anatomy. Materials and Methods: A total of 880 consecutive patients who underwent RARP from January 1, 2007 to December 31, 2014 were included with prospectively collected data in cross-sectional analysis. Erectile function (EF) was assessed preoperatively and postoperatively at 3, 6, 12, and 24 months using the International Index of Erectile Function (IIEF)-5, a percent erection fullness compared to preoperative status, and two Expanded Prostate Cancer Index (EPIC) questions: (1) are erections firm enough for penetration and (2) are they satisfactory? Results: Two hundred thirty-one (33.1%) men had APAs transected. There were no significant differences in baseline demographics or clinical characteristics in men with or without APAs transected. Multivariate analyses demonstrated that age (confidence interval [95% CI]: 0.94, 0.99) and baseline IIEF-5 (95% CI: 1.15, 1.26) strongly correlated with recovery of erections and potency. Transection of APAs was not a significant predictor of erectile dysfunction (ED). Conclusion: Good surgical technique dictates the preservation of APAs. However, when preservation is questioned, we found that APA transection had no measurable effect on recovery of erections or potency regardless of age, preoperative ED, or number of APAs transected.

    KW - Accessory pudendal artery

    KW - Postoperative sexual function

    KW - Prostate cancer

    KW - Redundant blood supply

    KW - Robotic prostatectomy

    UR - http://www.scopus.com/inward/record.url?scp=85034623462&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85034623462&partnerID=8YFLogxK

    U2 - 10.1089/end.2017.0542

    DO - 10.1089/end.2017.0542

    M3 - Article

    C2 - 28859491

    AN - SCOPUS:85034623462

    VL - 31

    SP - 1170

    EP - 1175

    JO - Journal of Endourology

    JF - Journal of Endourology

    SN - 0892-7790

    IS - 11

    ER -