Detailed Anatomy of Penile Neurovascular Structures: Surgical Significance

Breza, J; Aboseif, Sherif R.; Orvis, Bradley R.; Lue, Tom F.; Tanagho, Emil A.

doi:10.1016/s0022-5347(17)40789-0

Cited by 254 publications

(101 citation statements)

References 24 publications

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“…The ability to recognize and quantify the nerve ®bers containing NOS is the best way to assess the integrity, pathway, degeneration or regeneration of erectile nerves. Breza and associates, 19 in cadaveric dissection, found nerve ®bers connecting the cavernous and dorsal nerves Ð a ®nding reaf®rmed by Paick et al 20 It appeared to them that the dorsal nerve serves as a`carrier' for the cavernous nerve, carrying these tiny ®bers to the distal corpora cavernosa and the glans. In the present study we found a distinct NOS staining pattern in the dorsal nerve and corpus cavernosum.…”

Section: Discussionmentioning

confidence: 93%

Traumatic arteriogenic erectile dysfunction: a rat model

et al. 2001

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We developed a rat model of traumatic arteriogenic erectile dysfunction (ED) for the study of vasculogenic ED. Bilateral ligation of the internal iliac artery was performed on 30 three-month old male Sprague ± Dawley rats as an experimental group. The control group consisted of 12 rats which underwent dissection of the internal iliac artery without ligation. Before their euthanization at 3 days, 7 days, and 1 month (10 rats in the experimental group and four rats in the control group at each time point), erectile function was assessed by electrostimulation of the cavernous nerves. Penile tissues were collected for nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining, trichrome staining, electron microscopy and RT-PCR for transforming growth factor beta (TGF-b1), insulin like growth factor-I (IGF-I) and ®broblast growth factors (FGF) mRNA expression. Electrostimulation of the cavernous nerves revealed a highly signi®cant declining of the intracavernous pressure after 3 and 7 days. No signi®cant recovery of erectile function was noted at 1 month. Histology showed degeneration of the dorsal nerve ®bers in all experimental rats. There was little decrease in the bulk of intracavernous smooth muscle in the experimental rats euthanazed 7 and 30 days. NADPH diaphorase staining revealed a signi®cant decrease in nitric oxide synthase (NOS) containing nerve ®bers in the dorsal and intracavernosal nerves in all rats in the experimental group. Electron microscopy showed a variety of changes such as collapse of sinusoids, increased cell debris, ®broblast and myo®broblast loss, intracellular deposition of fat and collagen and fatty degeneration. RT-PCR revealed up-regulation of TGF-b1 after 3 days but not after 7 days or 1 month. There is no signi®cant difference in IGF-I or FGF expression between the experimental and control group. Bilateral ligation of internal iliac arteries produces a reliable animal model for traumatic arteriogenic ED. Further studies are needed to investigate the molecular mechanism of ED in this model.

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Section: Discussionmentioning

confidence: 93%

Traumatic arteriogenic erectile dysfunction: a rat model

et al. 2001

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“…Patient age and surgical technique, as well as possible injury to accessory pudendal arteries have all been suggested as potential explanations. 25,32,33 The results of the present physiological observations in the rat model, when taken in conjunction with the human histological data, suggest the possibility that the ancillary penile nerves are physiologically relevant and that injury to them during radical extirpative surgery may further impair penile erection. Clearly, additional study is needed to con®rm the importance of these ancillary branches of human penile nerves.…”

Section: Discussionmentioning

confidence: 57%

Significant physiological roles of ancillary penile nerves on increase in intracavernous pressure in rats: experiments using electrical stimulation of the medial preoptic area

et al. 2001

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The objectives of this work were to evaluate the contributions of the ancillary penile nerves to penile erection in male rats in vivo. We investigated the effects of unilateral and bilateral transection of the cavernous nerve (main penile nerve) on the increase in intracavernous pressure (ICP) following electrical stimulation of the medial preoptic area (MPOA) in male rats in vivo. After unilateral or bilateral transection of the cavernous nerve (main penile nerve), the ICP responses showed decreases of 28% and 55%, respectively compared to those ICP responses before transection. In other words, even after bilateral transection of the cavernous nerve, signi®cant increases in the ICP response following central stimulation were observed. In contrast to these ®ndings, the ICP response was completely eliminated following bilateral pelvic nerve transection. These data suggested that the ancillary penile nerves, which originate from the major pelvic ganglia, have a complementary role to the cavernous nerves in the autonomic motor innervation of the penis.

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“…Signi®cant variation in the blood supply to the penis was found by Breza et al in a study of adult male cadavers. 12 In their dissections they found an accessory internal pudendal artery in seven of 10 cadavers, predominantly on the left. These traveled along the lower aspect of the bladder and the anterolateral surface of the prostate to the dorsal root of the penis.…”

Section: Vascular Anatomymentioning

confidence: 97%

Medical and surgical advances in the radical prostatectomy patient

Nehra

2000

Int J Impot Res

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Maintaining the quality of life after surgery in the radical prostatectomy patient is of paramount importance. One of the major dilemmas in surgical management of radical retropubic prostatectomy (RRP) is preservation of the neurovascular bundle and, hence, erectile function and the continence mechanism. This manuscript addresses anatomical considerations for the surgeon and discusses the following issues with regard to medical and surgical therapies: (1) incidence of erectile dysfunction solely due to complications during RRP; (2) nerve damage during RRP; (3) vascular damage during RRP; (4) current medical and surgical therapies for restoring or maintaining potency; and (5) new advances on the horizon for management of the prostatectomy patient.

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Detailed Anatomy of Penile Neurovascular Structures: Surgical Significance

Cited by 254 publications

References 24 publications

Traumatic arteriogenic erectile dysfunction: a rat model

Traumatic arteriogenic erectile dysfunction: a rat model

Significant physiological roles of ancillary penile nerves on increase in intracavernous pressure in rats: experiments using electrical stimulation of the medial preoptic area

Medical and surgical advances in the radical prostatectomy patient

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