Vascular Supply

The principal arterial supply to the prostate is provided by branches of the inferior vesical artery, which is in turn supplied by the hypogastric artery. The capsular artery and its branches run posteriolateral to the prostate in parallel with the cavernosal nerves. The branches of the capsular artery enter the prostate at a right angle and can be sources of bleeding during dissection, while the artery itself terminates in the pelvic diaphragm. Occasionally an aberrant pudendal artery can be seen coursing lateral to the prostate. The effort to preserve this during surgery may aid in preserving erectile function postoperatively.6

The urethral arteries enter the prostate at the junction of the bladder neck and prostate from four quadrants (at 11, 1, 5 and 7 o'clock) and then run parallel with the urethra. The blood supply of the seminal vesicle and vas deferens comes from the vesiculodeferential artery, which in turn is a branch of the superior vesicular artery. Of technical concern is the consistent, significant blood supply encountered at the tip of the seminal vesicle, which should be controlled in all cases to avoid unnecessary and annoying blood loss during this portion of the operation.

The venous supply of the penis and prostate can present a considerable challenge and be the source of significant morbidity, if difficulty is encountered with these structures during

Prostate Cancer: Science and Clinical Practice dissection. The dorsal venous complex emerges from the pubic arch, and develops anterior and posterior components. The anterior vessels splay over the surface of the prostate, and can be variable in their size and density. Bunching of these vessels can prevent significant back bleeding during dissection.7-10 The posterior divisions of these veins run along neurovascular bundles running posterior lateral to the prostate.

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