Cavernospongious Shunts: Anatomical Study of Intrapenile Vascular Pathways

Droupy, S.; Giuliano, François; Jardin, A; Galand, Benoît

doi:10.1159/000067983

Cited by 18 publications

(13 citation statements)

References 12 publications

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“…No agreement has been reached about the behavior of these vessels within the corpus spongiosum. Whereas Wagner et al assess that these vessels are shunts connecting the cavernosal artery with the sinusoidal spaces of the corpus spongiosum [4], more recent studies suggest that they are arterial anastomoses connecting the cavernosal artery with the urethral arterial network [5,6].…”

Section: Introductionmentioning

confidence: 99%

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

et al. 2002

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Our objective was to investigate prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC). These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Sixty-one consecutive patients underwent penile color Doppler US. Waveform changes in CSC were evaluated in comparison with changes in the cavernosal artery. Eighteen of 61 patients had normal erection, 17 of 61 had arterial insufficiency, and 26 of 61 had veno-occlusive dysfunction. Resistance index (RI) in CSC was significantly lower than in cavernosal arteries in all patients and increased during phases 1-2 (positive diastolic flow). Peak systolic velocity (PSV) in CSC was significantly higher in the patients with veno-occlusive dysfunction. During cavernosal phase 4 (diastolic flow reversal) CSC of patients with normal erection or with arterial insufficiency disappeared, underwent markedly reduced diastolic flow, or had systolic flow inversion. Conversely, low resistance flow was appreciable in CSC of patients with veno-occlusive dysfunction who reached phase 4. During phase 5 (systolic peak reduction) all CSC disappeared. Color Doppler US allows evaluation of CSC both in patients with normal and impaired erection.

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Section: Introductionmentioning

confidence: 99%

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

et al. 2002

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“…Wagner et al (1982) described shunts between the CC and the CS. Our team has confirmed the existence of these shunts via operating microscope dissection after intra-arterial injection of colored latex (Droupy et al 1999a). Anastomoses have been confirmed by Costabile et al (1998).…”

Section: Introductionmentioning

confidence: 72%

“…Droupy et al (1999a) in dissection assisted by an operating microscope, described 6-10 anastomoses between the cavernous artery and the CS. Conti (1952) also described arterial anastomoses between the cavernous arteries and the urethral arteries in the distal parts of the penis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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“…Extensive mobilization of the male urethra may injure the urethral blood supply and spongiosclerosis or vascular erectile dysfunction may develop. 23,24 Also, according to the law of Laplace over stretching the male urethra decreases its lumen and may cause high bladder pressure during voiding. 25 Despite differences in structure the whole urethra and each urethral segment have similar extensibility.…”

Section: Resultsmentioning

confidence: 99%

Urethral Extensibility Applied to Reconstructive Surgery

Silva

Sampaio

2002

Journal of Urology

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Purpose: The human male urethra has great capacity to extend under traction. This extensibility is the principle of some surgical techniques used to overcome urethral defects and for penile lengthening. However, to our knowledge safe limits of urethral extensibility in reconstructive surgery have not been yet established by a morphological study. To this end we measured fresh human cadaveric urethras with and without traction.Materials and Methods: We analyzed the macroscopically normal, fresh cadaveric urethra from 25 men 6 months to 73 years old at death (mean age 30.6). Penile length and length of the total, penile, bulbar and membranous urethra were measured. Length under maximal constant traction and the maximal stretched length without penile curvature at artificial erection were determined. Extensibility is expressed as the percent of the variation in initial length at rest and maximal constant traction length. Maximal stretched length without penile curvature at artificial erection is expressed as a percent of maximal constant traction length.Results: Total urethral extensibility was higher than penile extensibility (p Ͻ0.001). Urethral extensibility decreased with aging (r ϭ Ϫ0.806, p Ͻ0.001). Mean extensibility of the whole male urethra was 66.2% Ϯ 7.2% and differences among urethral segments were not significant (p ϭ 0.283). Mean maximal stretched length without penile curvature at artificial erection was 75.2% Ϯ 3.8% and it did not change with age.Conclusions: Knowledge of the safe anatomical limit of urethral extensibility applied to reconstructive surgery may avoid complications and the necessity for more complex techniques. This limit should be approximately 75% of the maximal constant traction length or a gap-tonormal urethra ratio of 1:4. However, age related variations should be considered.KEY WORDS: urethra, penis, reconstructive surgical procedures, elasticityThe human male urethra can be divided into the prostatic, membranous and spongy urethral segments, which have structural differences. The spongy urethra, also called the anterior urethra due to its location, consists of an almost central tunnel of urothelial mucosa supported by a network of interconnected spaces lined with endothelium surrounded by a thin fibrous envelope. The lamina propria of the mucosa is loose connective tissue with abundant elastic networks. No independent submucosa layer is distinguishable. The anterior urethra is composed of a large portion of extracellular matrix distributed in a unique structure. Smooth muscle cells and elastic fibers are major components of the extracellular matrix and, in addition to the spongy feature, they provide the human male urethra with a large capacity to extend under traction. 1 This extensibility is the principle of several surgical techniques used to correct urethral defects and more recently provide a real increase in penile length. 2-10 While excessive mobilization of the spongy urethra is not desirable, the success rate of these surgical techniques depends on the possibil...

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Cavernospongious Shunts: Anatomical Study of Intrapenile Vascular Pathways

Cited by 18 publications

References 12 publications

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

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

Urethral Extensibility Applied to Reconstructive Surgery

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