Penile Veins Are the Principal Component in Erectile Rigidity: A Study of Penile Venous Stripping on Defrosted Human Cadavers

Abstract

The human erectile mechanism is an intricate interplay of hormonal, vascular, neurological, sinusoidal, pharmacological, and psychological factors. However, the relative influence of each respective component remains somewhat unclear, and merits further study. We investigated the role of venous outflow in an attempt to isolate the key determinant of erectile function. Dynamic infusion cavernosometry and cavernosography was conducted on 15 defrosted human cadavers, both before and after the systematic removal and ligation of erection-related penile veins. Preoperatively, an infusion rate of more than 28.1 mL/min (from more than 14.0 to 85.0 mL/min) was required to induce a rigid erection (defined as intracavernosal pressure [ICP] exceeding 90 mmHg). Following surgery, we were able to obtain the same result at a rate of 7.3 mL/ min (from 3.1 to 13.5 mL/min) across the entire sample. Thus, we witnessed statistically significant postoperative differences (all P # .01), consistently elevated ICP, lower perfusion volumes, and a general reduction in time taken to attain rigidity. The cavernosograms provided further evidence substantiating the critical role played by erection-related veins, whereas histological samples confirmed the postoperative integrity of the corpora cavernosa. Given that our use of cadavers eliminated the influence of hormonal, arterial, neurological, sinusoidal, pharmacological, and psychological factors, we believe that our study demonstrates that the human erection is fundamentally a mechanical event contingent on venous competence.

Herb formula enhances treatment of impotent patients after penile venous stripping: a randomised clinical trials

“…Clinically refined PVS benefits most impotent males (Hsu et al ., ). This belief was further supported after a couple of recent studies on fresh and defrosted human cadavers, while a fully rigid erection was readily attainable and maintainable after penile erection‐related veins were thoroughly stripped and ligated closest to the tunica albuginea (Hsieh et al ., ; Hsu et al ., ). An easier intracorporeal fluid retention was reported by those who were not satisfied with PVS alone.…”

Surgical niche for the treatment of erectile dysfunction

“…In tandem with a better understanding of penile venous anatomy, painstaking studies have been carried out on defrosted and fresh cadavers to omit the psychological impact on penile erection . Investigators concluded that penile veins are crucial in attaining a rigid erection . Renovation of the venous anatomy of the penis has inspired the latest refinement of venous surgery.…”

“…23 Investigators concluded that penile veins are crucial in attaining a rigid erection. [112][113][114] Renovation of the venous anatomy of the penis has inspired the latest refinement of venous surgery. Hsu et al resorted to an even more radical technique, refined penile venous stripping, achieved using local anesthesia as an ambulatory surgery.…”

The current situation in penile transplantation; a morphological evaluation

“…[17][18][19] Bu venlerin ereksiyonda esas etkili venler oldu¤u gösterilmitir. [20,21] Derin venler; V. cavernosa (v. profunda penis), fascia profunda'nın altında ayrı bir ba¤ dokusu perivasküler kılıfın içinde tunica albuginea'ya yakın olarak, v. dorsalis profunda penis ile a. dorsalis profunda penis arasında bulunurlar (ekil 1). V. cavernosa'lar, v. emisseria'lar aracılı¤ı ile corpus cavernosum'lardan, kanı drene ederler.…”