勃起關鍵的人類陰莖纖維血管終極解密總成是心臟血管系統新聠圖
許耕榕1,2,4、謝政興3、張宏江4、殷約翰2、陳明村2
栩仕診所1,2,4書田泌尿眼科診所2、泌尿部慈濟醫院3、台大醫院4
An Updated Reconstruction-Related Penile Fibro-Vascular Anatomy
Geng-Long Hsu1,2,4, Cheng-Hsing Hsieh3, Hong-Chiang Chang4, Jue-Hawn Yin2, Ming-Tsun Chen2
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology1
,Yin Shu-Tien Memorial Hospital Shu-Tien Urology Ophthalmology Clinic2
, Department of Urology Taipei Tzuchi Hospital3 and National Taiwan University hospital4, Taipei, Taiwan
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology1
,Yin Shu-Tien Memorial Hospital Shu-Tien Urology Ophthalmology Clinic2
, Department of Urology Taipei Tzuchi Hospital3 and National Taiwan University hospital4, Taipei, Taiwan
Purpose: The human penis has current form for three-thousand centuries and extensive research has been conducted since the renaissance, this peculiar organ was not thoroughly elucidated and so did relevant male potency reconstructive strategies until our efforts in the latest three decades. To summarize recent studies, we sought to update the discovery of the penile fibro-vascular assembly which substantiates the penile vascular diseases.
Material and methods: On 111 consecutive formalin-fixed cadaveric penises, using surgery scalpel, dissecting light, scanning, and a transmission electron microscope, the erection-related fibro-vascular architecture was studied. Dynamic cavernosometry was conducted on 48 male cadavers in whom 5 fresh and 43 defrosted human penises were used respectively chronologically.
Results: The major fibro-skeleton of the human penis is the tunica albuginea of the corpora cavernosa, which is a bi-layered structure consisting of 360o inner circular and 300o outer longitudinal collagen bundles. Although there is no os penis in the human glans, an os analog- the distal ligament that acts as a trunk of the glans penis. Intracavernosal pillars enhance the fibro-skeleton perpendicularly. The erection-related veins composed of a single deep dorsal vein, a pair of cavernosal veins, and two pairs of para-arterial veins that are distributed between the tunica albuginea and Buck’s fascia. Furthermore, a rigid erection is categorically reachable in a dramatically lower perfusion rate in every cadaveric penis once the visible emissary veins are occluded closet the outer tunica albuginea. In addition, the outer tunica plays a determinant role in the penile veno-occlusive physiology, as evidenced by preventing the electrocautery effect to the cavernosal sinusoids if intracavernosal pressure is raised to 120 mmHg. The bi-layered model of the tunica albuginea is essential to the veno-occlusive mechanism, penile morphology, and implant protection, and the erection-related veins are intriguingly complex. Both have been overlooked even though they are essential to human erectile function, plausibility, the conventional endovascular intervention is not physiologically feasible.
Conclusion: These newfound insights into penile tunica, venous anatomy, and erection physiology were inspired by and, in turn, enhance clinical applications routinely encountered by physicians and surgeons, such as penile morphological reconstruction, penile implantation, and penile venous stripping surgery.