Moderated Poster

Poster, Podium & Video Sessions

MP18-05: Prostatic Arterial Variants: Lessons Learned from Interventional Radiology

Friday, May 12
3:30 PM - 5:30 PM
Location: BCEC: Room 153

Presentation Authors: Jessica Jackson*, Charlottesville, VA, George Rueb, Charlottesville , VA, Andre Uflacker, Ziv Haskal, Noah Schenkman, Charlottesville, VA

Introduction: Major urologic reference texts describe the prostatic artery originating from the Inferior Vesical artery. The advent of prostate artery embolization (PAE) has led interventional radiologists to identify variable anatomy. Our objective is to describe the variable origins of the prostatic artery (PA) identified during initial experience with PAE.

Methods: Prostatic arteries were identified from both computerized tomographic (CT) and catheter angiography. Two operators independently evaluated the anatomy of each pelvic half. The origin of each prostatic artery was categorized as follows: Common Anterior Gluteo-pudendal Trunk, Inferior Gluteal, Inferior Vesical, Internal Pudendal, Obturator, and Superior Vesical arteries (Figure 1). Cross-pelvic collateralization was also assessed.

Results: Thirty six arteries were evaluated in 26 pelvic halves in 13 patients. Sixty two percent (n=8/13) had independent ipsilateral PAs on one or both sides of the hemipelvis. Symmetric origins were noted in only 23% (n=3). The most common PAs origin was the Internal Pudendal artery (36%, n=13/36), followed by the Obturator artery (31% n=11/36) (Figure 2). The Inferior Vesical artery was the least common origin (3% (n=1/36) of the cohort. Eight patients underwent PAE, and 5 (38%, n=5/13) showed collateral flow between the right and left prostatic arterial supplies.

Conclusions: PAE challenges established concepts of prostate arterial supply by demonstrating high variability. In this study, we confirm the significant heterogeneity of prostatic arterial origins, with the most common published origin being the least common configuration we encountered. Additionally, collateralization underscores the complexity of prostatic arterial supply. Current technology demonstrates that descriptions in urology texts may be overly simplistic. Updated understanding of PA anatomy is essential for PAE, but may also have urological implications related to procedural efficacy or even potency given the predominance of arteries originating from the Internal Pudendal artery.

Source Of Funding: none

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