Edorium Journal of

Anatomy and Embryology

 
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Editorial
 
Dissection steps for cadaveric penile disassembly
Loreto C.1, Sansalone S.2
1Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy.
2Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.

Article ID: 100007A04LC2015
doi:10.5348/A04-2015-7-ED-6

Address correspondence to:
Carla Loreto
MD, Associate Professor of Anatomy, Department of Biomedical and Biotechnological Sciences
Section of Human Anatomy and Histology, University of Catania
Italy
Phone: +39 095 378 2038
Fax: +39 095 378 2046

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Loreto C., Sansalone S. Dissection steps for cadaveric penile disassembly. Edorium J Anat Embryo 2015;2:27–29.


Urogenital anatomy is the basis for medical student and surgeon training alike. A critical part of the andrology surgeon's understanding of the genitourinary apparatus and morphology comes from cadaveric dissection. Anatomical dissection provides an unparalleled practical knowledge of penile structures. Human penile disassembly was first described by S.V. Perovic [1], who specialized in correcting complex penile deformities consequent to Peyronie's disease, but the technique can be extended to organ reconstruction for a variety of penile diseases [2]. The steps involved in cadaveric penile dissection and disassembly are described below.

Recommended equipment:

  • Dissection scalpel
  • Dissection scissors
  • Super-light titanium needle holder
  • Vicryl™ 4/0 (polyglactin 910) suture for the circumferential subcoronal incision.

Procedure: The penis is degloved through a circumferential subcoronal incision: dissection involves the relatively avascular plane between Buck's fascia and dartos fascia. The urethra is dissected off the tunica albuginea by two longitudinal paraurethral incisions of Buck's fascia, one on each side of the urethra (Figure 1), in the avascular plane above the tunica albuginea of the corpora cavernosa, enabling the urethra to be literally lifted off the corpora cavernosa. Care is taken to remain in the plane between the corpus spongiosum and the corpus cavernosum, because on the ventral aspect of the corpus cavernosum the tunica albuginea is made up of only two layers and is extremely thin. The urethra is completely dissected off the corpora cavernosa down to its bulbous portion, to maximize tissue length and elasticity (Figure 2). Next Buck's fascia, containing the dorsal neurovascular bundle, is dissected and mobilized dorsally off the tunica albuginea by combined sharp and blunt dissection. At this time communication between the cavernosal and dorsal arteries, which may lead to postoperative arteriogenic erectile dysfunction, must be excluded because it is a contraindication for total penile disassembly. Buck's fascia is dissected off the corpora cavernosa from the penile root to the groove of the glans; the deep dorsal vein runs longitudinally in the middle of the neurovascular bundle with a dorsal artery and a dorsal nerve on each side. Complete dissection of the urethra and Buck's fascia off the corpora cavernosa is shown on slings for demonstration purposes in Figure 3. Blunt dissection of the glans penis off the tips of the corpora cavernosa with scissors is then performed, carefully avoiding injury to the tunica albuginea, leaving any spongy tissue on the corpora cavernosa, or damaging the dorsal penile arteries that reach the glans lateral to the deep dorsal vein. After complete dissection of the glans, Buck's fascia and urethra, the corporal tips are completely denuded Figure 4 and penis disassembly is complete (Figure 5).

Re-assembly is always performed for ethical reasons. It involves replacing the glans cap on the tip of the corpora cavernosa with a 4/0 polyglactin 910 mattress suture; repositioning Buck's fascia and the urethra respectively on the dorsal and ventral aspect of the corpora cavernosa, and closing the two paraurethral incisions of Buck's fascia with a running 4/0 polyglactin 910 suture, to prevent postoperative mobilization and hematoma formation. Skin re-approximation along the subcoronal circumferential incision with interrupted 4/0 sutures completes the re-assembly.

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Figure 1: Carla Loreto, Giulio Garaffa, Rados Dijnovic, Guido Barbagli, Massimo Villa, Salvatore Sansalone"Penile disassembly: anatomical surgical steps" BJU Int 2013; 112(7): 1035-45, p.1036. Copyright [2013 BJU International]. "This material is reproduced with permission of John Wiley & Sons, Inc."


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Figure 2: Carla Loreto, Giulio Garaffa, Rados Dijnovic, Guido Barbagli, Massimo Villa, Salvatore Sansalone"Penile disassembly: anatomical surgical steps" BJU Int 2013; 112(7): 1035–45, p.1037 Copyright [2013 BJU International]. "This material is reproduced with permission of John Wiley & Sons, Inc."


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Figure 3: Carla Loreto, Giulio Garaffa, Rados Dijnovic, Guido Barbagli, Massimo Villa, Salvatore Sansalone"Penile disassembly: anatomical surgical steps" BJU Int 2013; 112(7): 1035–45, p. 1040. Copyright [2013 BJU International]. "This material is reproduced with permission of John Wiley & Sons, Inc."


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Figure 4: Carla Loreto, Giulio Garaffa, Rados Dijnovic, Guido Barbagli, Massimo Villa, Salvatore Sansalone"Penile disassembly: anatomical surgical steps" BJU Int 2013; 112(7): 1035–45, p. 1041. Copyright [2013 BJU International]. "This material is reproduced with permission of John Wiley & Sons, Inc."



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Figure 5: Carla Loreto, Giulio Garaffa, Rados Dijnovic, Guido Barbagli, Massimo Villa, Salvatore Sansalone"Penile disassembly: anatomical surgical steps" BJU Int 2013; 112(7): 1035–45, p. 1042. Copyright [2013 BJU International]. "This material is reproduced with permission of John Wiley & Sons, Inc."


Acknowledgements

Pedzisai Mazengenya helped in reviewing the final paper.


References
  1. Perovic SV, Vukadinovic V, Djordjevic ML, Djakovic N. The penile disassembly technique in hypospadias repair. Br J Urol 1998 Mar;81(3):479–87.   [CrossRef]   [Pubmed]    Back to citation no. 1
  2. Loreto C, Garaffa G, Dijnovic R, Barbagli G, Villa M, Sansalone S. Penile disassembly: anatomical surgical steps. BJU Int 2013 Nov;112(7):1035–45.   [CrossRef]   [Pubmed]    Back to citation no. 2

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Author Contributions:
Loreto C. – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sansalone S. – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Loreto C. et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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