For patients with Prostate Cancer advances in medical technology have enabled us to identify
"accessory" (additional) pudendal arteries (called APA) while performing a laparoscopic
radical prostatectomy (a scope with a video camera is used during the surgery). APAs
running near the prostate gland are identified in approximately 1 in 3 to 4 patients.
However, large APAs, like the ones looked for in this study, are identified in 15-18% of all
patients. These arteries are preserved more than 80% of the time, depending on their size
and location.With this study, we plan to evaluate whether APAs supply blood to the penis and
male erections, as well as the amount supplied.
Overall, approximately 50% of patients become impotent (inability to achieve or maintain an
erect penis; also called erectile dysfunction) after radical prostatectomy (removal of the
prostate). It is already known that postoperative (after surgery) erectile dysfunction does
not depend solely on the preservation of the nerves going to the penis, but also to the
preservation of the arteries bringing blood to the penis.
Although, the presence and frequency of APAs have been studied, and the ability to preserve
them has also been noted, we still do not know how much these arteries contribute to a
male's erection. With this study, we plan to evaluate whether APAs supply blood to the penis
and male erections, as well as the amount supplied. While there is no immediate benefit to
you for participating in the study, these findings will further help our understanding of
APA's and the importance in preserving them during surgery.
The primary aim of this study is to determine the proportion of men with APAs for whom APAs
contribute to penile blood flow. The secondary aim is to describe peak systolic, diastolic
and resistive index velocities of the dorsal artery of the penis before and after clamping
of the APA.
- They have selected a LRP, with or without robotic assistance, by Jonathan Colelman,
MD, Bertrand Guillonneau, MD, Vincent Laudone, MD, Raul Parra, MD, or Karim Touijer
MD for definitive treatment of their prostate cancer after a full discussion of
- Patients undergoing Open Radical Prostatectomy
- Patients with prior history of insulin dependent diabetes mellitus
- Patient who have received prior radiation therapy to the pelvis or prostate
- Patients requiring anticoagulation postoperatively
- Known allergy to Phenylephrine, Alprostadil, Papaverine or Phentolamine
- Patients whose systolic blood pressure is below 90 mmHg at the time of evaluation
despite routine measures taken by the anesthesiologist at his best criteria.
- Patients with labile hypertension or history of prior priapism
- Patients with penile scarring or penile prosthesis
- Patients with an International Index of Erectile Function score < 24