Department of Urology, Itabashi Chuo Medical Center, Tokyo, Japan.
J Endourol. 2024 Jun;38(6):564-572. doi: 10.1089/end.2023.0724. Epub 2024 Apr 23.
We herein describe the superficial preprostatic vein (SPV) anatomy and determine its relationship with the accessory pudendal artery (APA). We reviewed 500 patients with localized prostate cancer who underwent conventional robot-assisted radical prostatectomy between April 2019 and March 2023 at our institution. SPV 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 APA was defined 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 SPV and APA was described. SPVs had a prevalence rate of 88%. They were preserved in 252 men (58%) and classified as I-, reversed-Y (rY)-, Y-, or H-shaped (64%, 22%, 12%, and 2%, respectively) based on their intraoperative appearance. Overall, 214 APAs were found in 142 of the 252 men with preserved SPV (56%; 165 lateral and 50 apical APAs in 111 and 41 men, respectively). SPVs were pulsatile in 39% men perhaps due to an accompanying tiny artery functioning as a median APA. Pulsations seemed to be initially absent in most SPVs 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 APA. 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 postprostatectomy erection. The Clinical Research Registration Number is 230523D.
我们在此描述了前列腺浅静脉（SPV）的解剖结构，并确定了其与副阴部动脉（APA）的关系。我们回顾了 2019 年 4 月至 2023 年 3 月期间在我院接受常规机器人辅助根治性前列腺切除术的 500 例局限性前列腺癌患者。SPV 被定义为“任何来自耻骨前列腺韧带之间的空间的静脉，在前列腺前方的耻骨后脂肪组织内运行，朝向膀胱静脉丛或骨盆侧壁”。而 APA 被定义为“任何位于前列腺周围区域的动脉，与背血管复合体平行运行，并向会阴前侧延伸至前会阴”。描述了每根 SPV 和 APA 的术中解剖结构。SPVs 的患病率为 88%。在 252 名保留 SPV 的男性（58%）中保留了它们，并根据术中表现将其分为 I 型、反向 Y（rY）型、Y 型或 H 型（分别为 64%、22%、12%和 2%）。总体而言，在 252 名保留 SPV 的男性中发现了 214 根 APA（56%；111 名和 41 名男性中分别有 165 根侧 APA 和 50 根顶 APA）。39%的男性 SPV 有搏动，可能是由于一根伴随的小动脉作为中间 APA 起作用。在大多数 SPV 中，搏动似乎最初不存在，但在手术后晚期变得明显，可能是由于前列腺切除后动脉和静脉血流增加所致。在有≥1 根 APA 的男性中，搏动很常见。这项描述前列腺周围动脉和静脉解剖结构及其保留技术的解剖变异的研究表明，保留这些脉管系统可能有助于保留前列腺切除术后的勃起。临床研究注册编号为 230523D。
