Does Accessory Pudendal Artery Preservation Increase the Risk of Positive Surgical Margins in Robot‐Assisted Radical Prostatectomy?

Objectives The accessory pudendal artery runs near the prostate, particularly in the apical region. We assessed whether its preservation during robot‐assisted radical prostatectomy increases the risk of positive surgical margins. Methods We retrospectively analyzed 272 men who underwent robot‐assisted radical prostatectomy between 2019 and 2023: 140 with accessory pudendal artery preservation and 132 without identifiable accessory pudendal arteries. One‐to‐one propensity score matching based on clinicopathological and MRI variables was used to balance covariates between groups. Positive surgical margin rates were compared before and after matching. Perioperative outcomes, including blood loss and operative time, were also compared. Results Before matching, the artery preservation group had a lower proportion of National Comprehensive Cancer Network high‐risk disease (52/140 [37%] vs. 69/132 [52%], p = 0.034) but similar positive surgical margin rates (30/140 [22%] vs. 28/132 [21%], p = 1). Among 38 patients with artery preservation ipsilateral to MRI‐detected apical tumors, positive margin rates were comparable to other preservation patterns (9/38 [24%] vs. 21/102 [21%], p = 0.8). After matching, 134 cases were assigned to the preservation group and 66 to the no‐artery group, with all standardized mean differences below 0.15. Positive margin rates remained similar (30/134 [22%] vs. 14/66 [21%]; p = 1), along with the location or length of positive margins. Perioperative outcomes were comparable. Conclusions This study demonstrated that accessory pudendal artery preservation does not adversely affect positive surgical margins and perioperative outcomes, thus supporting its routine preservation. Further studies are needed to assess long‐term oncological outcomes and explore its role in postoperative functional recovery.