Dorsal Artery Branches to the Corpora Cavernosa

Abstract

ABSTRACT Introduction Understanding the penile arterial anatomy and its preservation is of interest to reconstructive and oncologic surgeons. The predominant cavernosal arterial supply is provided by the cavernous artery (CA) as it branches from the internal pudendal artery (IPA). Penile ultrasound and cavernosography have demonstrated the existence of accessory arteries originating from the dorsal artery of the penis (DA). Assessment of the arterial anatomy has largely been limited to imprecise ultrasound or invasive angiography. Objective To describe the anatomic findings relating to DA branching patterns in the penis among men undergoing CT cavernosography for evaluation of sexual dysfunction. Methods Images from CT cavernosography were reviewed in a sequential cohort of men. Imaging was reviewed to delineate the arterial anatomy with respect to the CA and DA branches distal to the pubic symphysis as noted by an absence of contrast in a linear hiatus within the corpora cavernosa. Data included the presence of an identifiable CA or DA branch, their diameters, the number of DA branches, distance from the pubic symphysis, and the approximate branching angle. Results 68 men had imaging available for analysis, 57 of whom underwent evaluation for ED and 37 for penile curvature. At least one CA was identifiable in 88% of men with a mean diameter of 1.66mm (Median 1.40, [IQR 1.30, 1.90]). DA perforating branches were identified in 90.8% of men, with a mean of 2.1 discrete branches per patient (Median 2, [IQR 1,3]). 26 men had penile doppler data available for comparison. Among those men, the mean CA diameter after injection was 1.51mm and the ratio between diameter measured on doppler and CT was 1.0. 4 patients had a DA branch identified on penile doppler and all had at least one DA branch identified on CT. 19 patients had at least one DA branch identified on CT which was not seen on penile doppler. In a subset of 33 patients with further CT data available for review, the mean number of DA branches identified was 2.24 (Median 2, [IQR 1,3]), with a mean DA branch diameter of 1.39mm (Median 1.40, [IQR 1, 1.70]). The first branch was identified at a mean of 2.06cm distal to the pubic symphysis with a branching angle of approximately 49.75 degrees, and the second branch was identified at a mean of 3.4cm distal to the pubic symphysis with a branching angle of approximately 50.62 degrees. Conclusions Dorsal artery contribution to the cavernosal blood supply may be more variable than previously thought. This is of interest to those performing penile doppler for assessment of blood flow given that it may be difficult to delineate the CA and DA in some patients. The impact of these DA branches on sexual function is not clear and warrants further investigation. Disclosure No