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Neuroanatomy of Penile Erection: Its Relevance to Iatrogenic Impotence

1984; Lippincott Williams & Wilkins; Volume: 131; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(17)50344-4

1527-3792

Tom F. Lue, Salim J. Zeineh, Richard A. Schmidt, Emil A. Tanagho,

Pediatric Pain Management Techniques

No AccessJournal of Urology1 Feb 1984Neuroanatomy of Penile Erection: Its Relevance to Iatrogenic Impotence Tom F. Lue, Salim J. Zeineh, Richard A. Schmidt, and Emil A. Tanagho Tom F. LueTom F. Lue , Salim J. ZeinehSalim J. Zeineh , Richard A. SchmidtRichard A. Schmidt , and Emil A. TanaghoEmil A. Tanagho View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)50344-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The neuroanatomy of erection in men is not well defined. Recently, we isolated successfully the cavernous nerves for acute and chronic neurostimulation to induce penile erection in dogs and monkeys. We then investigated the anatomy of these nerves in humans by cadaveric dissection and serial histologic sectioning. Our experience in tracing the spinal nuclei responsible for vesical and urethral function by transportation of horseradish peroxidase enabled us to explore the location and organi;ation of the spinal center for erection. Thus, systemic knowledge of the neuroanatomy of erection was accumulated. The spinal nuclei for control of erection are located in the intermediolateral gray matter at the Sl to S3 and Tl2 to L3 levels in dogs, and the S2 to S4 and TlO to L2 levels in humans. From these sacral nuclei axons issue ventrally and join the axons of the nuclei for the bladder and rectum to form the sacral visceral efferent fibers. These fibers emerge from the anterior root of S2 to S4, and join the sympathetic fibers to form the pelvic plexus, which then branches out to innervate the bladder, rectum and penis. The fibers innervating the penis (cavernous nerves) travel along the posterolateral aspect of the seminal vesicle and prostate, and then accompany the membranous urethra through the genitourinary diaphragm. These fibers are located on the lateral aspect of the membranous urethra and ascend gradually to the 1 and 11 o'clock positions in the proximal bulbous urethra. Some of the fibers penetrate the tunica albuginea of the corpus spongiosum, while others spread to the trifurcation of the terminal internal pudendal artery and innervate the dorsal, deep and urethral arteries. Shortly before the 2 corpora cavernosa merge the cavernous nerves penetrate the tunica albuginea along with the deep artery and cavernous vein. The terminal branches of these nerves innervate the helicine arteries and the erectile tissue within the corpora cavernosa. Because of the intimate relationship of the cavernous nerves to the rectum, prostate and urethra, they can be damaged easily during urological and pelvic procedures. This systemic knowledge of the human cavernous nerves from the spinal center to the erectile tissue should permit a better understanding of erection and impotence. Furthermore, with the aid of intraoperative neurostimulation, the cavernous nerves may be identified and preserved, thereby preventing iatrogenic impotence. © 1984 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByBlakely S, Caza T, Landas S and Nikolavsky D (2018) Dorsal Onlay Urethroplasty for Membranous Urethral Strictures: Urinary and Erectile Functional OutcomesJournal of Urology, VOL. 195, NO. 5, (1501-1507), Online publication date: 1-May-2016.Erickson B, Granieri M, Meeks J, Cashy J and Gonzalez C (2018) Prospective Analysis of Erectile Dysfunction After Anterior Urethroplasty: Incidence and Recovery of FunctionJournal of Urology, VOL. 183, NO. 2, (657-661), Online publication date: 1-Feb-2010.Anger J, Sherman N and Webster G (2018) The Effect of Bulbar Urethroplasty on Erectile FunctionJournal of Urology, VOL. 178, NO. 3, (1009-1011), Online publication date: 1-Sep-2007.Burnett A and Lue T (2018) Neuromodulatory Therapy 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(2018) Note by EditorJournal of Urology, VOL. 133, NO. 2, (212-212), Online publication date: 1-Feb-1985. Volume 131Issue 2February 1984Page: 273-280 Advertisement Copyright & Permissions© 1984 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Tom F. Lue More articles by this author Salim J. Zeineh More articles by this author Richard A. Schmidt More articles by this author Emil A. Tanagho More articles by this author Expand All Advertisement PDF DownloadLoading ...