title: Tunical Outer Layer Plays an Essential Role in Penile Veno-occlusive Mechanism Evidenced from Electrocautery Effects to the Corpora Cavernosa in Defrosted Human Cadavers.
abstract: OBJECTIVE
  To determine the exact anatomical structure for establishing penile veno-occlusive function, we sought to conduct a hemodynamic study on defrosted human cadavers.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
authors.forename: Cheng-Hsing
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Department of Physiology, China Medical University, Taichung, Taiwan.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Huang
authors.affiliation: Department of Anatomy, China Medical University, Taichung, Taiwan.
authors.forename: Mang-Hung
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Department of Medical Informatics & Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Heng-Shen
authors.initials: HS
authors.lastname: Chen
authors.affiliation: Department of Plastic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors.forename: Po-Cheng
authors.initials: PC
authors.lastname: Huang
authors.affiliation: Department of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chung-Wu
authors.initials: CW
authors.lastname: Lin
authors.affiliation: Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei, Taiwan. Electronic address: genglonghsu@gmail.com.
authors.forename: Geng-Long
authors.initials: GL
authors.lastname: Hsu
mesh_terms: D000368:Aged; D002102:Cadaver; D004564:Electrocoagulation; D007172:Erectile Dysfunction / Q000503:physiopathology; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000098:blood supply*; D011312:Pressure; D014680:Veins / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*