Hsieh Cheng-Hsing, Huang Yi-Ping, Tsai Mang-Hung, Chen Heng-Shen, Huang Po-Cheng, Lin Chung-Wu, Hsu Geng-Long
Department of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
Department of Physiology, China Medical University, Taichung, Taiwan.
Urology. 2015 Dec;86(6):1129-35. doi: 10.1016/j.urology.2015.07.054. Epub 2015 Sep 30.
To determine the exact anatomical structure for establishing penile veno-occlusive function, we sought to conduct a hemodynamic study on defrosted human cadavers.
Thirteen penises were used for this experiment, and 11 intact penises were allocated into the electrocautery group (EG, n = 6) and the ligation group (LG, n = 5). A circumcision was made on the penis to access the veins. Two #19 scalp needles were fixed in the 3 and 9 o'clock positions in the distal penis for colloid infusion and intracavernous pressure (ICP) monitoring, respectively. For the EG, the deep dorsal vein and cavernosal vein trunks were freed for 3-5 cm where at least 3 emissary veins were identified via opening Buck's fascia; these veins underwent electrocautery at 45 watts, while the ICP was maintained at 0, 50, 75, 100, 125, and 150 mmHg, respectively. For control, venous ligation was made but at the ICP of 150 mmHg. A tissue block including the emissary vein was then obtained for histological analysis.
Except all in the EG and those whose ICP exceed 125 mmHg in the EG, the sinusoids of the corpora cavernosa sustained varied fulgurated fibrosis in every specimen and the severity appeared reversely commensurate with the ICP regarding sinusoidal clumping and darkish bands (P <.02 and .01 respectively).
We conclude that the tunica albuginea can prevent the electrocautery damage to intracavernous sinusoids once the ICP reached a level corresponding to a rigid erection. The outer tunica plays an essential role in fulfilling the veno-occlusive mechanism.
为确定建立阴茎静脉闭塞功能的确切解剖结构，我们试图对解冻后的人体尸体进行血流动力学研究。
本实验使用了13个阴茎，其中11个完整阴茎被分为电灼组（EG，n = 6）和结扎组（LG，n = 5）。对阴茎进行环切以暴露静脉。将两根#19头皮针分别固定在阴茎远端3点和9点位置，用于胶体输注和海绵体内压（ICP）监测。对于电灼组，游离背深静脉和海绵体静脉干3 - 5厘米，通过打开白膜识别至少3条导静脉；这些静脉在45瓦功率下进行电灼，同时ICP分别维持在0、50、75、100、125和150 mmHg。作为对照，在150 mmHg的ICP下进行静脉结扎。然后获取包括导静脉的组织块进行组织学分析。
除电灼组所有样本以及电灼组中ICP超过125 mmHg的样本外，每个标本的海绵体窦均出现不同程度的电灼后纤维化，其严重程度在窦状聚集和深色带方面与ICP呈反向对应关系（分别为P <.02和.01）。
我们得出结论，一旦ICP达到与坚硬勃起相对应的水平，白膜可防止电灼对海绵体窦造成损伤。外层白膜在实现静脉闭塞机制中起重要作用。
