PD36-10 MICROANATOMY AND INNERVATION PATTERNS OF THE SPERMATIC CORD IN HUMANS

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research II1 Apr 2015PD36-10 MICROANATOMY AND INNERVATION PATTERNS OF THE SPERMATIC CORD IN HUMANS Koji Shiraishi, Shintaro Oka, and Hideyasu Matsuyama Koji ShiraishiKoji Shiraishi More articles by this author , Shintaro OkaShintaro Oka More articles by this author , and Hideyasu MatsuyamaHideyasu Matsuyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2259AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Understanding of the spermatic microanatomy is important during the microsurgical denervation of the spermatic cord (MDSC) and varicocelectomy. Anatomical information regarding spermatic vessels has been well documented; however, the locations of the lymphatics and nerves and the types of nerve fibers have been poorly investigated. The purposes of this study are to document the distribution of lymphatics and nerves and identify the types of nerve fibers in the human spermatic cord. METHODS Between August 2013 and August 2014, a total of 33 men (17 to 43 years old) underwent microsurgical inguinal varicocelectomy (n=23) or MDSC (n=10) and agreed with the purpose of this study. The outer half of the spermatic fascia was resected intraoperatively to 2 cm, fixed with formalin and immunostained with antibodies against a lymphatic marker D2-40, a pan-neuronal marker PGP9.5, a sympathetic marker tyrosine hydroxylase (TH), a parasympathetic marker vasoactive intestinal polypeptide (VIP), and a sensory nociceptor marker calcitonin gene-related peptide (CGRP). The innervation density was examined in patients subdivided according to the presence of orchalgia. The same analyses were performed using the whole sections of the spermatic cord that were obtained from 10 patients with testicular cancer who had undergone an orchiectomy. RESULTS The spermatic fascia was composed of mainly smooth muscle fibers. The mean number of lymphatics in the spermatic fascia was 0.4, and lymphatics were found in 26% of the men. The majority of lymphatics were localized in the intraspermatic cord. The mean number of nerve fibers that were positive for PGP9.5 in the spermatic fascia was 7.2. Ninety percent of the PGP9.5-positive fibers were also positive for CGRP, and 75% of the fibers were positive for TH but not for VIP. The number of CGRP-positive fibers was significantly higher in men with orchalgia than in men without orchalgia (p<0.05). In the spermatic cord, both PGP9.5- and TH-positive fibers were distributed (mean number: 8.9), and the distribution of the CGRP fibers in the intraspermatic cord was sparse, except for around the vas. CONCLUSIONS The CGRP-positive sensory nerve is considered to be involved in the pathophysiology of chronic orchalgia, and the transection of spermatic fascia and nerve fibers around the vas is extremely important during MDSC. The post-operative scrotal hydrocele may not be a problem if several lymphatics are preserved in the spermatic cord. Sympathetic fibers in the spermatic fascia and cord may contribute to the contraction of spermatic muscle and testicular blood regulation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e768-e769 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Koji Shiraishi More articles by this author Shintaro Oka More articles by this author Hideyasu Matsuyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...