[Abstract] Objective To study the anatomical relationship between the prostatic artery and the ureter. Methods The travel of prostatic artery and the relationship between the position of prostatic artery and ureter were observed in 29 adult cadavers. Results The nearest distance from the cross of ureter and vas deferens to the prostatic artery was 6.19+0.53 mm, the vertical distance from the cross of ureter and vas deferens to the prostatic sulcus of the bladder was 39.95+1.12 mm; the nearest distance from the ureter through the bladder to the prostatic artery was 9.35+0.56 mm, and the nearest distance from the ureter through the bladder to the prostatic sulcus was 19.99+0.98 The vertical distance from the branch point of the prostatic artery trunk to the prostatic sulcus was 21.04+1.39 mm. Conclusion Ligation of the prostatic artery at a distance of 20-30 mm above the prostatic sulcus of the bladder is likely to cause ureteral injury and can only ligate 77.60% of the arterial trunk. The best location for ligation should be 30-40 mm above the prostatic sulcus.
[Keywords] prostatic artery, ureter, ligated artery, prostatectomy
Ligation artery prostate removal is now widely used in clinical urology [1.3.4.6]. Although anatomical data on this procedure have been reported in China [4.5.7], there is less information on the relationship between the prostatic artery and the ureter. For this reason, the authors observed the relationship of the prostatic artery and its prostatic branches to the ureter in order to provide a morphological basis for ligated arterial prostate removal.
Materials and Methods
A total of 58 sides of 29 adult cadavers fixed with formalin solution were dissected out of the prostatic artery and its branches within the lateral ligament of the bladder, where the portion of the ureter before it penetrates the bladder wall was exposed. The course of the prostatic artery was carefully observed. Since both the lateral bladder ligament and the bladder prostatic sulcus are relatively fixed and are not affected by bladder filling, vernier calipers are used to measure: (1) the nearest distance from the intersection of the ureter and the vas deferens (hereafter referred to as the ureteral intersection) to the prostatic artery and the vertical distance to the bladder prostatic sulcus; (2) the nearest distance from the ureter into the bladder to the prostatic artery and the vertical distance to the bladder prostatic sulcus; (3) the nearest distance from the main branch of the prostatic artery to the ureter The nearest distance from the ureter to the ureter and the vertical distance to the prostatic sulcus of the bladder (attached figure). The above vertical distances refer to the distance between two points that are perpendicular to the horizontal line.
Results
I. Location and course of the prostatic arteries
The prostatic artery was located on the superficial side of the lateral ligament of the bladder, and was directed from the external and superior side to the posterior, internal and inferior side of the prostate, parallel to the ureter that traveled on the deep side of the lateral ligament of the bladder. According to statistics, 41 prostatic arteries traveled in front of the external ureter, accounting for 70.69% of the total, and 17 traveled in the posterior ureter, accounting for 29.31% of the total. The prostatic arteries enter the prostatic sulcus of the bladder via the anterolateral aspect of the seminal vesicle gland and are distributed in the prostate gland. (The left and right data measured in this paper were statistically processed without side differences, so both sides were combined).
Second, the nearest distance from the ureteral crossing to the prostatic artery and the vertical distance to the prostatic sulcus of the bladder
The nearest distance from ureteral crossing to prostatic artery on 58 sides was measured as 6.19+0.53 (2.0~25) mm, and the vertical distance from ureteral crossing to prostatic sulcus of bladder was 39.95+1.12 (25~65), mm, and the distribution of both is shown in Table 1
Table 1 Distribution of the nearest distance from the ureteral crossing to the prostatic artery and the vertical distance to the prostatic sulcus of the bladder (mm)
Ureteral crossings to prostatic artery nearest distance
Vertical distance from ureteral crossing to prostatic sulcus of bladder
Range
n
Occurrence rate (%)
Range
N
Occurrence rate (%)
0~<5
33
56.9
20~<30
9
15.52
5~<10
19
32.76
30~<40
32
55.17
10~<15
4
6.9
40~<50
13
22.42
15~<20
1
1.72
50~<60
3
5.17
20~<25
1
1.72
60~<70
1
1.72
Total
58
100
58
100
Third, the nearest distance from the ureteral penetration of the bladder to the prostatic artery and the vertical distance to the prostatic sulcus of the bladder
After 58 side statistics, the nearest distance from the ureteral penetration of the bladder to the prostatic artery was 9.35+0.56 (2.0~20) mm, and the vertical distance from the ureteral penetration of the bladder to the prostatic sulcus was 19.99+0.98 (3.0~42) mm, and the distribution of both is shown in Table 2.
Table 2 Distribution of the nearest distance from the ureteral penetration of the bladder to the prostatic artery and the vertical distance to the prostatic sulcus of the bladder (mm)
Nearest distance from the ureteral penetration of the bladder to the prostatic artery
Vertical distance from the ureteral penetration of the bladder to the prostatic sulcus of the bladder
range
n
Occurrence rate (%)
Range
n
Occurrence rate (%)
0~<5
13
22.41
0~<10
4
6.89
5~<10
24
41.38
10~<20
32
55.17
10~<15
18
31.03
20~<30
19
32.76
15~<20
3
5.17
30~<40
1
1.72
40~<50
2
3.45
Total
58
100
58
100
Fourth, the nearest distance from the branch point of the main trunk of the prostatic artery to the ureter and the vertical distance to the prostatic sulcus of the bladder
The nearest distance from the branch point of the trunk of the prostatic artery to the ureter was 8.75+0.78 (3.0~25) mm on 40 sides, and the vertical distance from the branch point of the trunk of the prostatic artery to the prostatic sulcus of the bladder was 21.04+1.39 (4.0~40) mm on 54 sides, and the distribution of both is shown in Table 3.
Table 3 Distribution of the closest distance from the branch point of the main trunk of the prostatic artery to the ureter and the vertical distance to the prostatic sulcus of the bladder (mm)
The nearest distance from the branch point of the main trunk of the prostatic artery to the ureter
Vertical distance from the branch point of the trunk of the prostatic artery to the prostatic sulcus of the bladder
Range
n
Occurrence rate (%)
Range
n
Occurrence rate (%)
0~<5
10
17.24
20~<30
11
18.97
5~<10
16
27.59
30~<40
17
29.31
10~<15
10
17.24
40~<50
16
27.59
15~<20
3
5.17
50~<60
6
10.34
20~<25
1
1.72
60~<70
4
6.89
Biprostatic artery
3
5.17
Biprostatic artery
3
5.17
Below the ureter into the bladder
15
25.86
Below the ureter into the bladder
1
1.72
Total
58
100
58
100
Discussion
The prostatic artery has different origins, but all enter the prostatic sulcus of the bladder from the superior lateral bladder [2]. The prostatic artery is superficial and constant in the lateral ligament of the bladder, and the pulsation of this artery is palpable during clinical surgery, which is conducive to separation and ligation; (2) the prostatic artery is parallel to the ureter in the lateral ligament of the bladder, and the two are close together. 70.69% of the prostatic arteries are located in the external anterior part of the ureter, and 29.31% of the prostatic arteries are located in the external posterior part of the ureter. The prostatic artery should be separated and ligated with due consideration to the deep side of the ureter parallel to it to prevent misligation of the ureter.
Clinically, the prostatic artery is often ligated at or 20-30 mm above the prostatic groove of the bladder, which is a simple and safe procedure [5]. In this paper, the vertical distance from the ureter through the bladder to the prostatic sulcus of the bladder was measured to be 19.99+0.98 (3.0~42) mm, and the nearest distance to the prostatic artery at this point was 9.35+0.56 (2.0~20) mm, so ligation of the prostatic artery about 20 mm above the prostatic sulcus of the bladder can cause ureteral injury, especially at the crossover of the ureteral vas deferens, where the nearest distance to the prostatic artery is 6.35+0.56 (2.0~20) mm. The closest distance to the prostatic artery is 6.19+0.53 (2.0~25) mm.
The location of the branching point of the prostatic artery trunk is not constant. The percentage of prostatic artery trunk branch points located above the ureter through the bladder was 72.73%, between the ureteral bladder and the cystoprostatic sulcus was 25.45%, and below the cystoprostatic sulcus was 1.82%. The results indicate that the occurrence of branching points of the prostatic trunk tends to decrease from top to bottom. If the prostatic artery is ligated at 20-30 mm above the bladder prostatic sulcus, only 77.60% of the trunk can be ligated, so the best location for ligating the prostatic artery should be 30-40 mm above the bladder prostatic sulcus.