What is the origin of the arterial vascularization of the corpora cavernosa? A computer‐assisted anatomic dissection study

Abstract

The purpose of this study was to identify the microscopic arterial vascularization of the corpora cavernosa (CC) of the penis using computer-assisted anatomic dissection (CAAD), determine the contribution of the different penile arteries towards this vascularization, detail the nature of cavernospongiosum shunts, and locate the anastomoses between these different arteries. Tissue specimens were taken from five donors who donated their bodies to science. The specimens were fixed in 10% formalin and sliced into a series of five 5-lm sections at intervals of 200 lm. The first section was stained with hematoxylin-eosin or Masson's trichrome and the second with anti-protein S100. The cavernous artery of the penis is not the only source of arterial vascularization of the CC. In four of the five cases studied, we found two to four perforating branches arising from the dorsal arteries of the penis that join up with the cavernous artery of the penis or that are solely responsible for the vascularization of the distal third of the penis. The bulbo-urethral and urethral arteries are situated outside of the tunica albuginea of the corpus spongiosum on their lateral and dorsal sides. The anastomoses do not occur between the cavernous artery of the penis and the corpus spongiosum but between the cavernous artery of the penis and the urethral artery on the surface of the tunica albuginea. All of these arteries are accompanied by nerve branches. The CC were found to be vascularized by both cavernous and dorsal arteries of the penis. Intrapenile vascularization is organized around four arterial axes, which are anastomosed by multiple neurovascular shunts.

The Visceromotor and Somatic Afferent Nerves of the Penis

“…This has been confirmed by functional magnetic resonance imaging studies of the regional activation of the male genital sensory cortex, which illustrated a sensory innervation of the deep penile tissue [22]. The cavernourethral vascular anastomoses are also innervated by the autonomic system, joining with the urethral and bulbourethral arteries [9].…”

“…It was also observed that, in the mobile part of the penis, both DNPs and CNs accompanied vascular anastomoses between the dorsal and the cavernous arteries of the penis. As a group, they establish the neurovascular intrapenile axis, which includes the dorsosomatic pathways (originating from underneath the levator ani muscle) and the cavernoautonomic pathways (originating from above the levator ani muscle) [9,19]. The number of these dorsocavernous arterial anastomoses is known to be variable; between two and four were identified in each individual in the present study [20].…”

“…Although these two systems are known to have pelvic and hilar contacts, their possible intrapenile pathways have not been explored [6–8]. In particular, a specific innervation of the intrapenile vasculatory anamastoses has been hypothesized but never investigated—despite its potentially important role in erectile physiology [1,9,10]. Finally, the functional distribution of the intrapenile nerve fibers has not been explored during conventional anatomic dissections.…”

Ligamentous structures in human glans penis

“…The fibrous bands firmly attached to the urethral wall with a constant thickness, or undulated while interrupted by the arteries of carvenospongiosum shunts (Diallo et al. ) and spongiosum tissues. This architecture did not reach the distal tip of the glans penis when it had a blunt end or radial shape (35.5% of cases).…”

Development of a novel topical formulation of glyceryl trinitrate for the treatment of erectile dysfunction

“…Effective pharmacological treatment of ED requires the delivery of vasoactive agents to the corpora cavernosa and retention within this compartment. Several studies, using microdissection [28,29] or spongiographic radiological contrast techniques [30,31] have described the presence of both arterial and venous shunts, that could constitute a viable route for delivery of vasoactive drugs from the surface of the spongiosal glans penis to the cavernosal compartment. As shown schematically in Fig.…”