Retrospective review of flow patterns following retropubic prostatectomy

ABSTRACT Aim of this study: We retrospectively evaluated penile inflows in 103 previously potent individuals who underwent standard nerve sparing radical retropubic prostatectomy (RRP) for

the treatment of prostate cancer. No effort to identify or spare the accessory pudendal artery (APA) was made in any case. Our goal was to investigate the role of the accessory internal

pudendal artery (APA) in the maintenance of erections in this population. We hypothesize that if the APA is present in a significant number of men, and its ligation significantly contributes

to post-RRP impotence, then there should be an increased incidence of asymmetry between R/L cavernous arterial flows among post RRP patients with vascular impotence. Materials and methods:

One hundred and three previously potent individuals complaining of persistent erectile dysfunction for at least six months after RRP were studied with color duplex Doppler, following age

specific dosing of PGE1. Vascular assessment was performed before and after self-stimulation, measuring peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI).

Erections were visually rated as inadequate (INA), adequate (ADE) for penetration, or excellent (EXC) with sustained rigidity for at least 20 min. Cavernous artery asymmetry (CAA) was

defined as a >10 cm/s difference between right and left sided arterial flows. Results: Mean duration between surgery and Doppler study was 14.7 months. 27 out of 103 (26%) of patients

developed excellent rigidity consistent with isolated neurogenic impotence (PSV=32.0 cm/s, mean RI=0.95); 24 out of 103 (23%) had adequate vascular responses making it impossible to infer

presence or absences of neurogenic impotence; 52 out of 103 (51%) had inadequate rigidity consistent with vascular insufficiency (PSV=23.7 cm/s, mean RI=0.66). We noted that of patients with

EXC response, 48% (13 out of 27) had CAA. Among patients with severe inflow disease (INA responders), CAA was seen in only 21% of cases (11 out of 52). Conclusions: The incidence of APA has

been reported as being from 4–70%, and its significance in the maintenance of erections has been questioned. Assuming that the APA provides significant inflow in some patients, we expected

an increase in CAA in individuals in whom it was sacrificed. We found a higher incidence of CAA among post-RRP patients with normal vascular erectile responses to PGE1 (48%) compared to men

with true vasculogenic impotence post-RRP (21%). These data do not support the importance of the APA in the maintenance of erections in the post-RRP patient. Access through your institution

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PROSTATIC HYPERPLASIA ON EJACULATORY FUNCTION: A SYSTEMATIC REVIEW Article 14 February 2024 AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Division of Urology, Hospital of the University of

Pennsylvania, Philadelphia, PA DS Blander, GA Broderick, SB Malkowicz, KN VanArsdalen & AJ Wein Authors * DS Blander View author publications You can also search for this author inPubMed

 Google Scholar * GA Broderick View author publications You can also search for this author inPubMed Google Scholar * SB Malkowicz View author publications You can also search for this

author inPubMed Google Scholar * KN VanArsdalen View author publications You can also search for this author inPubMed Google Scholar * AJ Wein View author publications You can also search

for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Blander, D., Broderick, G., Malkowicz, S. _et al._ Retrospective

review of flow patterns following retropubic prostatectomy. _Int J Impot Res_ 11, 309–313 (1999). https://doi.org/10.1038/sj.ijir.3900455 Download citation * Received: 27 July 1998 *

Revised: 01 September 1998 * Accepted: 19 April 1999 * Published: 12 January 2000 * Issue Date: 01 December 1999 * DOI: https://doi.org/10.1038/sj.ijir.3900455 SHARE THIS ARTICLE Anyone you

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Springer Nature SharedIt content-sharing initiative KEYWORDS * vasculogenic impotence * color Doppler ultrasonography * prostatectomy