Dorsal penile artery

The penis is supplied by both somatic and autonomic nerves. The somatic dorsal nerves provide sensory innervation (as well as provide some degree of autonomic function) for the penile skin and glans, and approximately follow the course of the dorsal penile arteries, eventually becoming the pudendal nerve (after joining with other nerves) and entering the... 

Common anatomical variations of penile arteries include asymmetry, bifurcated cavernosal artery, multiple cavernosal arteries, presence of recurrent branches, unilateral origin of all cavernosal branches, accessory cavernosal branches, and aberrant origin from the dorsal artery (Fig. 5.5). Occasionally the cavernosal artery consists of multiple short, rapidly tapering segments, periodically reconstituted by perforating vessels from the dorsal penile artery (Juskiewenski et al. 1982 Wahl et al. 1997). 

Armenakas NA, Hochberg DA, Fracchia JA (2001) Traumatic avulsion of the dorsal penile artery mimicking a penile fracture. J Urol 166 619... 

The internal pudendal artery becomes the common penile artery after giving off a branch to the perineum. The three branches of the penile artery are the dorsal, bulbourethral, and cavernous arteries. The cavernous artery is responsible for tumescence... 

A full evaluation of penile arteries is obtained during the onset of erection. In this phase it is possible to study the pathway of the cavernosal, dorsal and urethral arteries and to identify the presence of anatomical variations and vascular communications. Conversely, depiction of penile veins increases during detumescence. 

Fig. 5.9a,b. Color Doppler appearance of arterial communications (arrowheads) among the penile arteries. Axial scans on the ventral aspect of the penis, a Communication between the right cavernosal and urethral artery, b Communication between the right dorsal and cavernosal artery... 

A variety of arterial communications is appreciable among the different arteries ofthe penis. In particular, communications between the cavernosal arteries are identified in virtually all patients. Arterial communications between the cavernosal and the urethral artery, between the cavernosal artery and the arteries of the hulb of the corpus spongiosum, and dorsal penile-cavernosal perforators are less common (Fig. 5.9). 

Postraumatic penile arterial obstruction characteristically involves the proximal portion of the dorsal penile and cavernosal arteries and the distal internal pudendal artery at the level of the urogenital diaphragm. The integrity of arterial vascular supply to the penis can be assessed by Doppler interrogation of the cavernosal arteries. A peak systolic velocity of 25 cm/s or less after prostaglandin El intracavernosal injection reflects arterial insufficiency (Fig. 12.11). 

Fig. 15.1. Penile arterial revascularization. Photograph showing the isolated epigastric artery before anastomosis with the dorsal artery at the root of the penis...

Hampson SJ, Cowie AG, Richards D, Lees WR (1992) Independent evaluation of impotence by colour Doppler imaging and cavernosometry. Eur Urol 21 27-31 Hwang TI, Liu PZ, Yang CR (1991) Evaluation of penile dorsal arteries and deep arteries in arteriogenic impotence. J Urol 146 46-49... 

Fig. 8.8a-c. Peyronie s plaques ( ) involving the adjacent structures, a Axial scan showing involvement of the penile septum, b Longitudinal scan showing encasement of the cavernosal artery (arrowheads), c Color Doppler longitudinal scan showing encasement of the dorsal artery (arrowheads)... 

Fig. 8.10a,b. Color Doppler ultrasound scans. Calcified dorsal plaques ( ). Normal penile vessels simulating plaque vascularization. a Axial scan showing left dorsal artery (open arrow) and an emissary vein passing through the plaque (arrowhead). b Communication between the cavernosal and the dorsal artery (arrowhead) passing though the plaque... 

In our opinion, the anastomosis according to the Sharlip technique is the best solution because it envisages a retrograde revascularization of the cavernous artery through the common penile trunk. For this reason we usually anastomosed the epigastric artery on the dorsal artery of the penis end-to-end in the proximal direction (Fig. 15.1). This technique has been associated with the most success and the fewest complications (Wespes et al. 2003). 

In patients undergoing vascular surgery for impotence, preoperative color Doppler ultrasonography is indicated to evaluate cavernosal arterial flows and to assess penile vascular anatomy, with concern for size of the dorsal arteries, for presence of anatomic variations and for collateral arterial vascular pathways (Bertolotto et al. 2005). 

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