人类阴茎神经组织密度和分布的免疫组织学研究:梯度假说。
Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis.
机构信息
Department of Morphological Sciences, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.
Department of Pathology, University Clinical Hospital, Santiago de Compostela, Spain.
出版信息
Int J Impot Res. 2023 May;35(3):286-305. doi: 10.1038/s41443-022-00561-9. Epub 2022 May 2.
Immunohistological patterns of density and distribution of neural tissue in the human penis, including the prepuce, are not fully characterized, and effects of circumcision (partial or total removal of the penile prepuce) on penile sexual sensation are controversial. This study analyzed extra- and intracavernosal innervation patterns on the main penile axes using formalin-fixed, paraffin-embedded human adult and fetal penile tissues, single- and double-staining immunohistochemistry and a variety of neural and non-neural markers, with a special emphasis on the prepuce and potential sexual effects of circumcision. Immunohistochemical profiles of neural structures were determined and the most detailed immunohistological characterizations to date of preputial nerve supply are provided. The penile prepuce has a highly organized, dense, afferent innervation pattern that is manifest early in fetal development. Autonomically, it receives noradrenergic sympathetic and nitrergic parasympathetic innervation. Cholinergic nerves are also present. We observed cutaneous and subcutaneous neural density distribution biases across our specimens towards the ventral prepuce, including a region corresponding in the adult anatomical position (penis erect) to the distal third of the ventral penile aspect. We also describe a concept of innervation gradients across the longitudinal and transverse penile axes. Results are discussed in relation to the specialized literature. An argument is made that neuroanatomic substrates underlying unusual permanent penile sensory disturbances post-circumcision are related to heightened neural levels in the distal third of the ventral penile aspect, which could potentially be compromised by deep incisions during circumcision.
人类阴茎(包括包皮)的神经组织密度和分布的免疫组织学模式尚未完全确定,而包皮环切术(部分或全部切除阴茎包皮)对阴茎性感觉的影响存在争议。本研究使用福尔马林固定、石蜡包埋的成人和胎儿阴茎组织、单染和双染免疫组织化学以及多种神经和非神经标记物,分析了主要阴茎轴的海绵体内外神经支配模式,特别关注包皮和包皮环切术的潜在性影响。确定了神经结构的免疫组织化学特征,并提供了迄今为止最详细的包皮神经供应的免疫组织学特征。阴茎包皮具有高度组织化、密集的传入神经支配模式,在胎儿发育早期就表现出来。自主神经支配方面,它接受去甲肾上腺素能交感神经和硝酸盐能副交感神经支配。也存在胆碱能神经。我们观察到,在我们的标本中,皮肤和皮下神经密度分布偏向于腹侧包皮,包括一个与成人解剖位置(阴茎勃起)相对应的区域,即阴茎腹侧远端的三分之一。我们还描述了沿阴茎纵轴和横轴的神经支配梯度的概念。结果与专门文献进行了讨论。有人认为,包皮环切术后出现异常永久性阴茎感觉障碍的神经解剖学基础与阴茎腹侧远端三分之一处神经水平升高有关,而这种神经水平可能会因包皮环切术中的深切口而受到影响。