Objectives. To provide a better understanding of the distribution of inguinal nodes in order to prevent the complications of unnecessary and extended dissections in penile cancer. Methods. The bilateral inguinal regions of 19 male cadavers were dissected. Nodal distribution was noted and quantified based on anatomical location. The superficial nodes were subdivided into quarters as follows: superomedial, superolateral, inferomedial, and inferolateral. Statistical analysis was performed comparing node distribution between quarters using one-way analysis of variance (ANOVA), and the unpaired T-test was used between superficial and deep nodes. Results. Superficial nodes were found in all inguinal regions studied (mean = 13.60), and their distribution was more prominent in the superomedial quarter (mean = 3.94) and less in the inferolateral quarter (mean = 2.73). There was statistical significance between quarters when comparing the upper group with the lower one (P = 0.02). Nodes were widely distributed in the superficial region compared with deep lymph nodes (mean = 13.60 versus 1.71, P < 0.001). Conclusions. A great number of inguinal lymph nodes are distributed near the classical anatomical landmarks for inguinal lymphadenectomy, more prominent in upper quadrants.

ObjectiveTo evaluate the effects of testosterone (T) on the maintenance of corpus cavernosum (CC) structure and apoptosis.MethodsAnimals were divided into three groups: sham operation group (n = 8) underwent sham operation; Orchiectomized (Orchiec)+ oily vehicle group (n = 8) underwent bilateral orchiectomy and received a single dose of oily vehicle by intramuscular injection (i.m.) 30 days after orchiectomy; and Orchiec + T group (n = 8) underwent bilateral orchiectomy and received a single dose of T undecanoate 100 mg/kg i.m. 30 days after the surgery. Animals were euthanized 60 days after the beginning of the experiment with an anesthetic overdose of ketamine and xylazine. Blood samples and penile tissue were collected on euthanasia. Azan's trichrome staining was used to evaluate smooth muscle, Weigert's Fucsin-Resorcin staining was used to evaluate elastic fibers and Picrosirius red staining was used to evaluate collagen. Apoptosis was evaluated using TUNEL technique.ResultsT levels decreased in Orchiec + oily vehicle when compared to sham operation and Orchiec + T groups (p < 0.001). T deprivation reduced trabecular smooth muscle content and penile diameter and T replacement maintained both parameters (p = 0.005 and p = 0.001, respectively). No difference was observed in the content of sinusoidal space (p = 0.207), elastic fibers (p = 0.849), collagen (p = 0.216) and in apoptosis (p = 0.095).ConclusionNormal testosterone levels maintain CC smooth muscle content and do not influence elastic fibers, collagen content and apoptotic index. Further studies should be performed in order to investigate the mechanisms by which androgen mediates its effects on CC structure.

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Introduction Erectile dysfunction (ED) is frequently associated to hypertension and antihypertensive drugs; however, the penile morphological aspects on these situations are poorly known. Aim Evaluate the penile morphology of untreated hypertensive rats and rats treated with enalapril or sildenafil alone or in combination to verify the hypothesis that morphological alterations promoted by hypertension on corpus cavernosum could be ameliorated by the use of angiotensin-converting enzyme inhibitors and/or phosphodiesterase type 5 inhibitors. Methods Fifty male rats were assigned into five groups: normotensive rats, untreated spontaneously hypertensive rats (SHRs), and SHR treated with enalapril or sildenafil alone or in combination. Blood pressure was measured weekly. At the conclusion of the study, the rats were euthanized, and their penises were collected for histomorphometrical analysis. Main Outcome Measures The cross-sectional areas of the penis, tunica albuginea, and corpus cavernosum were measured. The density of the corpus cavernosum structures was quantified. Results Both groups of SHR rats treated with enalapril became normotensive. Untreated SHR showed no difference in penile and cavernosal cross-sectional area compared with normotensive rats; however, those rats treated with enalapril or sildenafil alone demonstrated an increase in these parameters. Rats receiving combination therapy showed no cross-sectional area differences compared with normotensive rats. Cavernosal connective tissue density was increased, while the sinusoidal spaces were diminished in untreated SHR. All treatments were effective in maintaining connective tissue density in comparison with normotensive animals. Cavernosal smooth muscle density was similar in all groups, with the exception of the combination therapy group, which demonstrated a reduction in smooth muscle. Conclusions Hypertension promoted structural alterations in the corpus cavernosum that may be related to ED. Enalapril- and sildenafil-treated animals had preservation of normal corpus cavernosum structure and an increase in penile and cavernosal cross-sectional area. The combination of these drugs showed less benefit than individual use.

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To evaluate, using quantitative and qualitative methods, the changes in the corpora cavernosa of patients with ischaemic priapism. PATIENTS AND METHODS We obtained samples of corpora cavernosa from seven patients with ischaemic priapism (mean age 38 years, range 28–44) who had a cavernous‐glandular shunt. The control tissues were fragments of corpora cavernosa obtained from autopsies of seven age‐matched men who died from causes unrelated to the urogenital tract. Histochemical and immunohistochemical techniques were used to assess and quantify the extracellular matrix and smooth muscle fibres. The volumetric density of smooth muscle, elastic fibres and collagen were determined in corpora cavernosa. RESULTS From the stereological analysis the mean (sd) values of volumetric density were: for collagen, control 34.76 (4.64), priapism 39.64 (2.91) (P = 0.002); elastic system fibres, controls 28.10 (2.85), priapism 36.10 (3.06) (P = 0.001); smooth muscle fibres, controls 43.37 (4.96), priapism 26.48 (5.00) (P < 0.001). There were significantly more fibrous elements of the connective tissue and significantly fewer smooth muscle fibres in the corpora cavernosa of patients with ischaemic priapism than in controls. CONCLUSION Ischaemic priapism is associated with early and significant changes in the components of the extracellular matrix and smooth muscle fibres of the corpora cavernosa. This could explain the frequent occurrence of erectile dysfunction found in patients with ischaemic priapism.

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In this animal model hypertension caused morphological changes in the testis and upon spermatozoid production. Enalapril treatment partially protected the testicles from these alterations, restoring normal spermatozoid production.

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