Accepted Manuscript 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 Author: Cheng-Hsing Hsieh, Yi-Ping Huang, Mang-Hung Tsai, Heng-Shen Chen, Po-Cheng Huang, Chung-Wu Lin, Geng-Long Hsu PII: DOI: Reference:
S0090-4295(15)00884-5 http://dx.doi.org/doi:10.1016/j.urology.2015.07.054 URL 19395
To appear in:
Urology
Received date: Accepted date:
4-2-2015 22-7-2015
Please cite this article as: Cheng-Hsing Hsieh, Yi-Ping Huang, Mang-Hung Tsai, Heng-Shen Chen, Po-Cheng Huang, Chung-Wu Lin, Geng-Long Hsu, Tunical Outer Layer Plays an Essential Role in Penile Veno-Occlusive Mechanism Evidenced From Electrocautery Effects to the Corpora Cavernosa in Defrosted Human Cadavers, Urology (2015), http://dx.doi.org/doi:10.1016/j.urology.2015.07.054. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Tunical Outer Layer Plays an Essential Role in Penile veno-occlusive Mechanism Evidenced from Electrocautery Effects to the Corpora Cavernosa in Defrosted Human Cadavers
Cheng-Hsing Hsieh MD 1, Yi-Ping Huang Ph D 2, Mang-Hung Tsai Ph D 3, Heng-Shen Chen MD & Ph D 4, Po-Cheng Huang MD 5 ,Chung-Wu Lin MD & Ph D 6, Geng-Long Hsu MD 7 1
Department of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical
Foundation; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan 2
Department of physiology,
3
Department of Anatomy, China Medical University, Taichung, Taiwan
4
Department of Medical Informatics & Family Medicine, College of Medicine,
National Taiwan University, Taipei, Taiwan 5
Department of plastic surgery, National Taiwan University Hospital Hsin-Chu
Branch, Hsin-Chu Branch, Taiwan 6
Department of pathology, College of Medicine, National Taiwan University, Taipei,
Taiwan 7
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology,
Taipei, Taiwan Correspondence/Reprint Requests: Geng-Long Hsu, MD
Microsurgical Potency Reconstruction and Research Center, Page 1 of 22
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3F 88, Wen-Hu Street Nei-Hu District 114, Taipei, Taiwan Phone:
886-2-87526087
Fax: 886-2-87975207 E-mail:
[email protected];
[email protected] Key Words: Penile veno-occlusive mechanism, electrocautery, deep dorsal vein, intracavernous pressure Running title: The tunica albuginea is the chief determinant of veno-occlusive function Acknowledgement We would like to thank Professor Gerald Brock for his English editing, along with Ms Hsiu-Chen Lu, Han-Ju Chen, Tzu-En Hsu and Venus Ying-Hui Chen their preparations of illustration and photos for this manuscript. 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 of adult human male defrosted cadavers were used for this experiment and 11 intact ones were allocated into electrocautery (n=6) and ligation (n=5) group respectively. A circumferential incision was made in order to access the veins. Two #19 scalp needles were fixed in the 3 and 9 o’clock positions in distal penis for colloid infusion and intracavernosal pressure (ICP) monitoring respectively. The deep dorsal vein and cavernosal vein trunks were freed for 3-5 cm where at least 3 emissary veins were Page 2 of 22
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identified via opening Buck’s fascia and undergone a 45 watts electrocautery while the ICP was maintained at 0, 50, 75, 100, 125 and 150 mmHg respectively. Correspondingly venous ligation was made for control but at the ICP of 150 mmHg. A tissue block including the emissary vein was then obtained for histological analysis. Results: But those in the ligation group and whose ICP exceed 125 mmHg in the electrocautery group, the sinusoids of the corpora cavernosa sustained varied fulgurated fibrosis in every specimen and its severity appeared reversely commensurate with the ICP in terms of sinusoidal clumping and darkish bands (P
