Penile Anatomy Under the Pubic Arch: Reconstructive Implications

Akman, Yavuz; Liu, Wenhui; Li, Ying Wu U.; Baskin, Laurence S.

doi:10.1016/s0022-5347(05)66131-9

Cited by 41 publications

(15 citation statements)

References 18 publications

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“…[1][2][3][4] Even without severe urological injury, damage to the delicate vascular and nervous tissues supplying the genitalia can result in sexual dysfunction. 5,6 Patients with polytrauma often have prolonged stays in hospital and require multiple operations on the pelvis, putting genitourinary structures at further risk of injury.…”

mentioning

confidence: 99%

Erectile dysfunction after fracture of the pelvis

Harwood

Grotz

Eardley

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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mentioning

confidence: 99%

Erectile dysfunction after fracture of the pelvis

Harwood

Grotz

Eardley

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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“…Every 10th section was stained with haematoxylin-eosin and Masson's trichrome; selected sections were stained immunohistochemically with antibodies raised against the neuronal marker S-100 (Dako Corporation, Carpinteria, CA, USA). The immunohistochemical techniques used were described previously [11][12][13]. Briefly, the avidin-biotin-peroxidase procedure was used (Vectastain ABC kit, Vector Laboratories, Burlingame, CA, USA) with cobalt intensification.…”

Section: Methodsmentioning

confidence: 99%

The neuroanatomy of the human scrotum: surgical ramifications

Yücel

Baskin

2003

BJU International

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The developmental neuroanotomy of the human scrotum may not have been evaluated up to now, but the authors from San Francisco report here on an outstanding study in foetuses of this important area of interest. They have helped to define clearly the neuroanotomy of this region, which will be useful in planning surgery to the scrotum and penis in children. The group from the Hospital for Sick Children in Toronto have evaluated the safety and efficacy of toleterodine in children who have previously failed to tolerate oxybutinin. They found that toleterodine is well tolerated in children, and 77% of patients were able to continue this treatment without significant side effects in this subgroup who could not tolerate oxybutinin. OBJECTIVE To define the scrotal nerve origin and distribution with respect to surrounding structures in male human fetuses, by using neuronal‐specific markers and three‐dimensional (3D) imaging techniques, as the developmental neuroanatomy of the human scrotum has not been studied in detail and an explicit description of nerve derivation and distribution in the human scrotum is germane to genital reconstructive surgery. MATERIALS AND METHODS Sixteen normal human fetal penile specimens at 17.5–38 weeks of gestation were studied. Specimens were fixed in formalin, embedded in paraffin wax, serially sectioned at 6 µm and stained with the neuronal marker S‐100. All of the specimens contained the whole penis and scrotum from glans to anal verge. The gestational age of the fetuses was determined by fetal heel‐to‐toe length. 3D‐computer reconstruction of serial sections allowed a detailed analysis of the neuroanatomy of the fetal penis and scrotum. RESULTS The nerves innervating the ventral side of the proximal penis and scrotum originated mainly from the perineal nerves arising from pudendal nerves. The nerves travelling along the ventral side of penis coalesced at the penoscrotal area to be directed into the interscrotal septum. At the penoscrotal junction, nerves on both sides of the ventral penis shifted to the interscrotal septum in a triangular fashion. The interscrotal septum was densely occupied by nerve fibres. Nerves were distributed horizontally to both hemiscrotal walls through this interscrotal septum. Both hemiscrota seem primarily to be innervated separately. CONCLUSION The interscrotal septum has a dense innervation. Both hemiscrota were innervated mainly by horizontally distributed nerve fibres arising from the interscrotal septum. Any procedure violating the penoscrotal and interscrotal septal area may jeopardize scrotal innervation.

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“…First, it runs in a close proximity to ramus inferior ossis pubis , then adjacent to inferior margin and anterior surface of corpus ossis pubis . At the apex of diaphragma urogenitale , nervus dorsalis penis courses via spatium subpubicum into the hiatus between diaphragma urogenitale and ligamentum pubicum inferius [4,5]. At the ventrocaudal margin of os pubis , nervus dorsalis penis runs in close proximity to the insertion site of the crus penis and further between crus penis and ventral surface of corpus ossis pubis to the dorsum penis .…”

Section: Anatomy Of Nervus Dorsalis Penis/clitoridismentioning

confidence: 99%

“…During the reconstruction of urethra posterior , the surgeon operates near nervus dorsalis penis , which can thus be damaged or cut [45]. During the hypospadia correction, the dorsal plication and mobilization of neurovascular bundle is performed [4,46]. The course of nervus dorsalis penis should be considered during the penile nerve block before the performance of circumcision [47–49].…”

Section: Clinical Considerations Of Nervus Dorsalis Penis/clitoridismentioning

confidence: 99%

“…For example, the reduction clitoridoplasty in girls with adrenogenital syndrome where mobilization and sparing of neurovascular bundle is performed, requires the ligation of corpora cavernosa in a close proximity to nervus dorsalis clitoridis running in the sulcus nervi dorsalis clitoridis [9,11,51,56]. Other examples include the insertion of transobturator suburethral vaginal tape for surgical treatment of female stress urinary incontinence [57–59] or mobilization and separation of common sinus into the urethra and vagina in the surgical treatment of congenital urogenital sinus anomalies [4,11,56]. The damage of nervus dorsalis clitoridis during these surgical approaches might cause complete insensitivity of clitoris, which leads to lower satisfaction during intercourse, whereas damage of arteria dorsalis clitoridis might cause peroperative bleeding and/or postoperative hematoma.…”

Section: Clinical Considerations Of Nervus Dorsalis Penis/clitoridismentioning

confidence: 99%

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Clinical Implications of a Close Vicinity of Nervus Dorsalis Penis/Clitoridis and Os Pubis

Šedý

Naňka

Špačková

et al. 2008

The Journal of Sexual Medicine

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Introduction Close relation of nervus dorsalis penis/clitoris and os pubis has a major impact in surgical disciplines. Aim To summarize a current knowledge about this region, represented by the course of sulcus nervi dorsalis penis/clitoridis. Methods Literature search of years 1970–2007. Main Outcome Measures In male, it accommodates nervus dorsalis penis whereas in female nervus et arteria dorsalis clitoridis. Lateral border of sulcus nervi dorsalis penis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc—two parameters, which are parts of the Phenice's method for sexing of isolated os pubis. Results Exact preparation of nervus dorsalis penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. Possible role of the sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of nervus dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of nervus dorsalis penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury to arteria dorsalis clitoridis leads to bleeding and/or hematoma. Conclusions Clinical anatomy of sulci is important in several situations in urologic surgery. It is possible to use sulcus nervi dorsalis penis/clitoridis for sexing of isolated pubis for antropological or forensic purposes.

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Penile Anatomy Under the Pubic Arch: Reconstructive Implications

Cited by 41 publications

References 18 publications

Erectile dysfunction after fracture of the pelvis

Erectile dysfunction after fracture of the pelvis

The neuroanatomy of the human scrotum: surgical ramifications

Clinical Implications of a Close Vicinity of Nervus Dorsalis Penis/Clitoridis and Os Pubis

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