The neuroanatomy of the human scrotum: surgical ramifications

Abstract

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.

Midline sensory nerve supply to the anoscrotal junction: a study using human male fetuses

“…Some of sensory nerve fibers of the posterior scrotal nerve were likely to reach the spinal dorsal root ganglion via the intrapelvic course such as the pelvic splanchnic nerves. Yucel and Baskin (2003) noted the midline course of the posterior scrotal nerve in view of kinds of plastic and reconstructive surgery. Notably, rather than the scrotum, the midline skin immediately anterior to the anus carried a considerably dense supply of thin sensory nerves.…”

“…The posterior part of the human scrotum is innervated by a branch of the pudendal nerve, i.e., the posterior scrotal nerve. From a surgical implication, Yucel and Baskin (2003) noted a fact that the posterior scrotal nerve runs though the perineal raphe (a subcutaneous, midline structure of the scrotum). However, these researchers did not demonstrate the nerve course from the laterally-located perineal nerve to the midline area.…”

Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves

“…The classical pattern of distribution and the terminal course of the ilioinguinal and genitofemoral nerve consistent with modern text descriptions were defined in only 20% of cadaveric dissections. 9,10 The dorsal penile nerve (pudendal nerve) is responsible for reflex erections. 11 Damage to the pudendal nerves (that is, Alcock syndrome) leads to erectile dysfunction.…”

The Distribution of Neuronal and Inducible Nitric Oxide Synthase in Urethral Stricture Formation

“…6 In a separate study we hypothesized the importance of these nNOS immunoreactive perineal nerves in erectile function since they communicate with the nNOS laden dorsal nerves. 12 NO is a well-known mediator of smooth muscle function in the urogenital system. Its function is essential in the smooth muscles of the corpora cavernosa to provide and maintain healthy erections.…”