The inferior vesical artery arises from the anterior division of the internal iliac artery in males, descending to supply the base of the bladder, the seminal vesicles, the vas deferens, and the prostate gland. It gives prostatic branches that are the dominant arterial supply to the prostate. In females the equivalent branches supply the vaginal walls and bladder base and are termed vaginal arteries.
The inferior vesical artery and its prostatic branches are the dominant blood supply to the prostate and must be individually ligated during radical prostatectomy to achieve haemostasis after the pedicle is divided. The neurovascular bundle of Walsh (containing the cavernous nerves) runs alongside the inferior vesical-prostatic vessels, and nerve-sparing prostatectomy requires dissection between the bundle and the vessel pedicle. In radical cystectomy, the inferior vesical artery pedicle is ligated en masse with the other vesical pedicles after the bladder is freed from its urethral attachment.
The inferior vesical-prostatic vascular pedicle is divided during radical prostatectomy after developing the lateral prostatic plane; inadequate haemostasis of this pedicle produces significant post-operative bleeding; in robot-assisted prostatectomy, early ligation of the posterior pedicle before lateral dissection reduces the risk of uncontrolled pedicle haemorrhage.
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