A New Technique to Map the Lymphatic Distribution and Alignment of the Penis

Abstract

The present study was to examine the distribution of lymphatic vessels in the penis of normal adult males, which could provide an anatomical basis for improvement of incisions in penile lengthening surgery, and may also help to prevent postoperative refractory edema. Thirteen normal adult male volunteers were recruited for this study. Contrast agent was injected subcutaneously in the foreskin of the penis, and after two minutes magnetic resonance lymphangiography (MRL) was performed. The acquired magnetic resonance images were analyzed to determine the changes in the number and diameter of lymphatic vessels in different parts of the penis. Maximum intensity projections (MIP) and materializes interactive medical image control system (MIMICS) were applied to analyze the overall distribution of lymphatic vessels in the penis. Magnetic resonance imaging (MRI) showed that the lymphatic vessels were in conspicuous contrast with surrounding tissues and could be clearly identified. Penile lymphatic vessels were clearly visible in the root of the penis. At the junction of the penis and the abdominal wall, all lymphatic vessels were found to be concentrated in the dorsal part of the penis. MIP two-dimensional reconstruction showed that the overall distribution of relatively large lymphatic vessels in the dorsal and ventral parts of the penis could be seen clearly on bilateral 45 position, but not inside the abdominal wall because some of lymphatic vessels were overlapped by other tissues in the abdomen. MIMICS threedimensional reconstruction was able to reveal the overall spatial distribution of lymphatic vessels in the penis from any angle. The reconstruction results showed that there were 1-2 main lymphatic vessels on the root of dorsal penis, which coursed along the cavernous to the first physiological curvature of the penis. Lymphatic vessels merged on both sides of the ventral penis. At the root of the penis, lymphatic vessels gradually coursed to the dorsal surface of the penis and folded at the abdominal wall to the outside, and finally merged into the inguinal lymph nodes. The changes in distribution, number and diameter of the lymphatic vessels in the penis were observed by MRI. MIP and MIMICS reconstructions directly revealed the anatomical features of penile lymphatic vessels such as spatial distribution, overall alignment, and the relations to adjacent structures, drainage

Visualization of Penile Suspensory Ligamentous System Based on Visible Human Data Sets

“…Even a 3D digital model built from thin-section MRI images cannot satisfactorily show the detailed anatomical features of these ligaments and surrounding structures [18,19]. Moreover, cadaver dissection and intraoperative observation may destroy the anatomical structures of the penis and relationships to the adjacent structures during the dissection process.…”

“…Furthermore, limited by image definition and contrast, with the traditional two-dimensional images, such as those derived from computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans, it is difficult to distinguish the penile ligaments [ 16 , 17 ]. Even a 3D digital model built from thin-section MRI images cannot satisfactorily show the detailed anatomical features of these ligaments and surrounding structures [ 18 , 19 ]. Moreover, cadaver dissection and intraoperative observation may destroy the anatomical structures of the penis and relationships to the adjacent structures during the dissection process.…”