The Artery Microanatomy Of Penis And Its Clinical Application

Background:Impotence is the most common male sexual dysfunction in clinic, with the incidence rate of 7% to 10%. About 30% of the patients belong to vascular impotence. The surgeons should be familiar with vascular distribution of penis in the surgical treatments of vascular impotence (such as reconstructive vascular operation and interruption of veins), replantation for penile trauma, surgical treatment of priapism, etc.Objective:To observe the courses, communications, distributions, and outer diameters of penile artery in different sections, and provide anatomical basis for replantation of penis and surgical treatments of vascular impotence.Methods:5 specimens were selected randomly, and were infused with latex through arteria carotis communis to produce microscopic anatomy specimens. Superficial dorsal penile artery, dorsal penile artery and deep dorsal penile artery were dissected to find the origin, shape, branches and their communications and outer diameter. The outer diameters of vessel were measured by vernier caliper with the precision of 0.02mm, and the data was processed by SPSS13.0.Results:1.The blood of penis is supplied by the internal pudendal artery and external pudendal artery.2.80% of the external pudendal arteries (4 cases) are directly derived from the medial wall of the femoral artery,20% (1 case) is derived from the femoral artery with the arteria epigastria superficialis. The penial branch of arteriae pudenda externae, which is the continuation of arteriae pudenda externae, comes into the penis through the superficial fascia and goes along both sides of the penis to distribute in the penile skin. The diameter in the base of the penis is 0.86±0.20mm. In 3 cases (60%), the trunk is single, and in 2 cases (40%) it divides into 2 branches.3. The internal pudendal artery divides into four terminal branches:dorsal penile artery, penile deep artery, urethral artery, and urethral artery.4. The dorsal artery of penis starts from the lower edge of the transverse ligament of the pelvis, passing by the medial side of the ligament of penis and going between the deep fascia and tunica albuginea. During the course,10-15 ring-arteries are sent to nourish cavernous body and capsule of the penis. In the5 cases, they all have 2 dorsal penile arteries, which are anastomosed to form an arch. The diameter of arteria dorsalis penis in the crus penis is 1.52±0.3mm. 5. The arteriae profunda penis enters cavernous body of penis to nourish it. And there are communicating branches between the arteries of cavernous body of penis. The arteriae profunda penis is the functional artery of penis.6. The blood of cavernous body of urethra is supplied by arteria bulbi urethrae and arteriae urethralis. The arteriae urethralis enters cavernous body of urethra near the crus of penis, having plenty communicating branches with arteria dorsalis penis. The arteries in cavernous body of urethra have 3～5 communicating branches with arteria dorsalis penis, and 4～6 communicating branches with arteriae profunda penis deep artery. The thickest diameter of communicating branches from arteriae profunda penis is 0.42±0.10mm.7. The blood of inner plate of praeputium penis is from arteria dorsalis penis, with 4～5 branches at atrioventricular furrow. The blood of outer plate of praeputium and skin of penis is supplied by superficial arteria dorsalis penis. The blood supply of inner and outer plate is consecutive.Conclusion:1.The blood supply of penis comes from superficial arteria dorsalis penis, dorsal artery of penis, deep dorsal penile artery, urethral artery and corpus spongiosum artery. Dorsal penile artery is derived from arteriae pudenda externae, while the others are from arteria pudenda interna.2. The blood of inner plate of praeputium penis is from arteria dorsalis penis, and the blood of outer plate of praeputium and skin of penis is supplied by superficial arteria dorsalis penis. The blood supply of inner and outer plate is consecutive.3. The dorsal artery of penis nourishes the capsule and skin of cavernous body of penis, and sends branches to nourish inner plate of praeputium penis. There are communicating branches between deep dorsal penile artery and penile artery in the penis. The arteria dorsalis penis communicates with arteriae urethralis through ring arteries, and nourshes caput penis.4. The arteriae profunda penis nourishes cavernous body. And there are communicating branches between the arteries of cavernous body of penis. The arteriae profunda penis is the functional artery of penis.5. The artery of cavernous body of urethraurethra has communicating branches with ring arteries from arteria dorsalis penis, arteriae profunda penis, and with arteria dorsalis penis at the caput penis.6. The anatomy of penile blood vessels provides anatomical basis for replantation and reconstruction of the penis, skin flap of acrobystia, and other operations about penis.