A detailed analysis of the penile fibro-vascular assembly.

Abstract

Background: Although various compartments of the human cardiovascular system have been thoroughly elucidated, the penile fibrovascular assembly remains an exception that has yet to be fully explored; therefore, this gap in our understanding prompts us to conduct further investigations.

Aim: This study revisits the penile-fibro-vascular assembly to determine whether it constitutes an independent vascular compartment within the human body.

Methods: The penile-fibro-vascular assembly was meticulously examined in 23 male human cadavers. The loupe-assisted observation was used to compare the size of bilateral penile arteries, conspicuously addressed at the hilum, and to isolate erection-related vascular channels meticulously with a loupe, as extensively as possible. Additionally, a comprehensive library was analyzed, including 801 cadaveric images, 1001 sets of dual cavernosographies, 11 spongiosographies, 7 Magnetic Resonance Imaging (MRI)/computed tomography (CT) cavernosographies, 61 Doppler's sonographies, and 15 selective internal pudendal arteriographies. Hemodynamic phenomena were observed both intra-corporeally and extra-corporeally in patients who underwent penile venous stripping (n = 501), coil embolization (n = 6), and pudendal arterial stenting (n = 5).

Outcomes: This study confirms the existence of an independent penile fibro-vascular hydraulic environment within the human cardiovascular system.

Results: The human penis contains an independent bi-layered fibrovascular assembly. Anatomical symmetry of bilateral arteries is rare on the arterial side. On the venous drainage side, there is one deep dorsal vein (DDV), two cavernosal veins, and four para-arterial veins, contrary to the conventional understanding of only a single DDV between the tunica albuginea and Buck's fascia. The penile venous drainage blood ultimately returns to pulmonary circulation.

Clinical implications: Penile vascular surgery, particularly penile venous stripping, is shown to be the most physiologically appropriate method for restoring erectile function; contrarily, erection-related arterial stents, or venous embolization do not offer similar benefits.

Strengths and limitations: This study's strength lies in its extensive analysis of a large repository of anatomical, physiological, radiographic imaging, and clinical vascular data; however, its retrospective nature represents a limitation.

Conclusion: This study demonstrates that the penile fibro-vascular assembly functions as an independent vascular system, substantially making it the last vascular compartment to be disclosed in the human body.