Online first
Original article
Published online: 2023-12-06
The complete anatomy of the prostatic artery: a meta-analysis based on 7421 arteries with implications for embolization and urological procedures
DOI: 10.5603/fm.97797
Pubmed: 38078735
Abstract
Background: The goal of the present meta-analysis was to offer physicians the most evidence-based data concerning the anatomical characteristics of the prostatic artery (PA).
Materials and methods: Medical databases including PubMed, Scopus, Embase, Web of Science, Google Scholar and Cochrane Library were searched trough. The overall search process was performed in 3 stages.
Results: The results were established based on a total of 7421 arteries. PA was found to originate from an internal pudendal artery with a pooled prevalence of 28.81% (95% CI: 26.23% - 31.46%). Mean diameter of the PA was found to be 1.52 mm (SE = 0.07). . Single PA was found to occur in 76.43% of the patients (95% CI: 60.96% - 89.12%).
Conclusions: In conclusion, the authors of the present study believe that this is the most accurate and up-to-date analysis regarding the highly variable anatomy of the PA. The PA originates most commonly from the internal pudendal artery (28.81%); however, it may also originate from other pelvic arteries, including the middle anorectal or the superior gluteal arteries. Moreover, accessory PAs may occur, yet, a single main PA supplying the prostate gland is most frequently observed (76.43%). The PA may also form anastomoses with the adjacent arteries (pooled prevalence of 45.20%), which may create a complex vascular network in the pelvis. It is hoped that the current meta-analysis may help to decrease the potential complications that may emerge from diverse endovascular and urological procedures.
Keywords: prostatic arterypelvisprostatesurgeryembolizationanatomy
References
- Amouyal G, Pellerin O, Del Giudice C, et al. Variants of patterns of intra- and extra-prostatic arterial distribution of the prostatic artery applied to prostatic artery embolization: proposal of a classification. Cardiovasc Intervent Radiol. 2018; 41(11): 1664–1673.
- Anract J, Amouyal G, Peyromaure M, et al. Study of the intra-prostatic arterial anatomy and implications for arterial embolization of benign prostatic hyperplasia. Prog Urol. 2019; 29(5): 263–269.
- de Assis AM, Moreira AM, de Paula Rodrigues VC, et al. Pelvic arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovasc Intervent Radiol. 2015; 38(4): 855–861.
- Bagla S, Rholl KS, Sterling KM, et al. Utility of cone-beam CT imaging in prostatic artery embolization. J Vasc Interv Radiol. 2013; 24(11): 1603–1607.
- Barral M, Gardavaud F, Lassalle L, et al. Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors. Eur Radiol. 2021; 31(9): 6471–6479.
- Bilhim T, Pisco JM, Furtado A, et al. Prostatic arterial supply: demonstration by multirow detector angio CT and catheter angiography. Eur Radiol. 2011; 21(5): 1119–1126.
- Bilhim T, Tinto HR, Fernandes L, et al. Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol. 2012; 15(4): 276–285.
- Boeken T, Gautier A, Moussa N, et al. Impact of anatomy type of prostatic artery on the number of catheters needed for prostatic artery embolization. Diagn Interv Imaging. 2021; 102(3): 147–152.
- Çelebioğlu E, Akkaşoğlu S, Çalışkan S, et al. Evaluation of the prostatic artery origin using computed tomography angiography. Anatomy. 2019; 12(3): 140–144.
- Clegg EJ. The arterial supply of the human prostate and seminal vesicles. J Anat. 1955; 89(2): 209–216.
- D'Antoni AV, Tubbs RS, Patti AC, et al. The critical appraisal tool for anatomical meta-analysis: a framework for critically appraising anatomical meta-analyses. Clin Anat. 2022; 35(3): 323–331.
- Eldem FG, Atak F, Öcal O, et al. Angiographic prostatic arterial anatomy in a Turkish population with benign prostatic hyperplasia. Turk J Med Sci. 2021; 51(2): 518–522.
- Enderlein GF, Lehmann T, von Rundstedt FC, et al. Prostatic artery embolization — anatomic predictors of technical outcomes. J Vasc Interv Radiol. 2020; 31(3): 378–387.
- Fenter TC, Naslund MJ, Shah MB, et al. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006; 12(4 Suppl): S90–S98.
- Fu JX, Wang M, Duan F, et al. Contrast-enhanced magnetic resonance angiography in the identification of prostatic arterial anatomy in patients with benign prostatic hyperplasia: prospective comparison with digital subtraction angiography. Clin Radiol. 2023; 78(3): e169–e176.
- Garcia-Monaco RD, Garategui LG, Onorati MV, et al. Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization. J Vasc Interv Radiol. 2014; 25(2): 315–322.
- Garcia-Monaco RD, Garategui LG, Onorati MV, et al. Cadaveric specimen study of prostate microvasculature: implications for arterial embolization. J Vasc Interv Radiol. 2019; 30(9): 1471–1479.e3.
- Groh A, Moore C, El-Warrak A, et al. Electroejaculation functions primarily by direct activation of pelvic musculature: Perspectives from a porcine model. Transl Res Anat. 2018; 10: 10–17.
- Hashem E, Elsobky S, Khalifa M. Prostate artery embolization for benign prostate hyperplasia review: patient selection, outcomes, and technique. Semin Ultrasound CT MR. 2020; 41(4): 357–365.
- Henry BM, Tomaszewski KA, Walocha JA. Methods of evidence-based anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat. 2016; 205: 16–21.
- Higgins JPT, Thomas J, Chandler J. et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons, Inc, Hoboken 2019.
- Iwanaga J, Singh V, Takeda S, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Khan R, Naidoo N, Lazarus L. Unique vascular patterns of the internal iliac artery and its clinical import in pelvic surgery. Transl Res Anat. 2021; 25: 100151.
- Knight GM, Talwar A, Salem R, et al. Systematic review and meta-analysis comparing prostatic artery embolization to gold-standard transurethral resection of the prostate for benign prostatic hyperplasia. Cardiovasc Intervent Radiol. 2021; 44(2): 183–193.
- Kurbatov D, Russo GI, Lepetukhin A, et al. Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study. Urology. 2014; 84(2): 400–404.
- Maclean D, Maher B, Harris M, et al. Planning prostate artery embolisation: is it essential to perform a pre-procedural CTA? Cardiovasc Intervent Radiol. 2018; 41(4): 628–632.
- Moore KL, Dalley AF, Agur A. Clinically oriented anatomy (8th ed). Lippincott Williams and Wilkins, Philadelphia 2017.
- Moulin B, Di Primio M, Vignaux O, et al. Prostate artery embolization: challenges, tips, tricks, and perspectives. J Pers Med. 2022; 13(1).
- Moya C, Cuesta J, Friera A, et al. Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy. Clin Anat. 2017; 30(1): 71–80.
- Nehra A, Kumar R, Ramakumar S, et al. Pharmacoangiographic evidence of the presence and anatomical dominance of accessory pudendal artery(s). J Urol. 2008; 179(6): 2317–2320.
- Ogawa Y, Hinata N, Murakami G, et al. Aspects of lymphatic vessel configuration of the human male urinary bladder and adjacent organs: A histological basis for understanding the spread of cancer metastases. Transl Res Anat. 2018; 11: 10–17.
- Ongidi I, Amuti TM, Abdulsalaam FY, et al. Variability in morphology and branching of the internal iliac artery: Implications for pelvic surgery. Transl Res Anat. 2021; 22: 100097.
- Ostrowski P, Bonczar M, Michalczak M, et al. The anatomy of the uterine artery: A meta-analysis with implications for gynecological procedures. Clin Anat. 2023; 36(3): 457–464.
- Schnapauff D, Maxeiner A, Wieners G, et al. Semi-automatic prostatic artery detection using cone-beam CT during prostatic arterial embolization. Acta Radiol. 2020; 61(8): 1116–1124.
- Secin FP, Karanikolas N, Kuroiwa K, et al. Anatomy of accessory pudendal arteries in laparoscopic radical prostatectomy. J Urol. 2005; 174(2): 523–6; discussion 526.
- Secin FP, Touijer K, Mulhall J, et al. Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol. 2007; 51(5): 1229–1235.
- Wang MQ, Duan F, Yuan K, et al. Benign prostatic hyperplasia: cone-beam CT in conjunction with DSA for identifying prostatic arterial anatomy. Radiology. 2017; 282(1): 271–280.
- Xu ZW, Zhou CG, Tian W, et al. Angiographic findings relevant to prostatic artery embolization in patients with prostate cancer. J Vasc Interv Radiol. 2020; 31(6): 899–902.e1.
- Xuan HN, Huy HDo, Bich NN, et al. Anatomical characteristics and variants of prostatic artery in patients of benign hyperplasia prostate by digital subtraction angiography. Open Access Maced J Med Sci. 2019; 7(24): 4204–4208.
- Zarzecki MP, Ostrowski P, Wałęga P, et al. The middle anorectal artery: a systematic review and meta-analysis of 880 patients/1905 pelvic sides. Clin Anat. 2022; 35(7): 934–945.
- Zelefsky MJ, Eid JF. Elucidating the etiology of erectile dysfunction after definitive therapy for prostatic cancer. Int J Radiat Oncol Biol Phys. 1998; 40(1): 129–133.
- Zhang G, Wang M, Duan F, et al. Radiological Findings of Prostatic Arterial Anatomy for Prostatic Arterial Embolization: Preliminary Study in 55 Chinese Patients with Benign Prostatic Hyperplasia. PLoS One. 2015; 10(7): e0132678.
- Zhang JL, Wang MQ, Shen YG, et al. Effectiveness of contrast-enhanced MR angiography for visualization of the prostatic artery prior to prostatic arterial embolization. Radiology. 2019; 291(2): 370–378.
