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Evolution in the concept of erection anatomy

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Abstract

Purpose

To review and to summarize the literature on anatomy and physiology of erection in the past three decades, especially the work done in our institution.

Methods

A search of the PubMed database was performed using keywords erection, anatomy and erectile dysfunction (ED). Relevant articles were reviewed, analyzed and summarized.

Results

Penile vascularisation and innervation vary substantially. Internal pudendal artery is the major source of penile blood supply, but a supralevator accessory pudendal artery that may originate from inferior vesical or obturator or external iliac arteries is not uncommon. Section of this artery during radical prostatectomy (RP) may adversely affect postoperative potency. Anastomoses between the supra and the infralevator arterial pathways are frequent. The cavernous nerves (CNs) contain parasympathetic and sympathetic nerve fibers and these nerves lie within leaves of the lateral endopelvic fascia. Anastomoses between the CNs and the dorsal nerve of the penis are common. Nitric oxide released from noradrenergic, noncholinergic neurotransmission of the CN and from the endothelium is the principal neurotransmitter-mediating penile erection. Interactions between pro-erectile and anti-erectile neurotransmitters are not completely defined. Finally, medial preoptic area and paraventricular nucleus are the key structures in the central control of sexual function and penile erection.

Conclusions

The surgical and functional anatomy of erection is complex. Precise knowledge of penile vascularisation and innervation facilitates treatment of ED especially after RP.

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Conflict of interest

None of the authors has any financial or personal relationship with other people or organisations that might have influenced the present work.

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Authors and Affiliations

  1. Laboratory of Experimental Surgery, UPRES 4122, Faculty of Medicine, University Paris-Sud, Le Kremlin Bicêtre, France

    Ayman Awad, Bayan Alsaid, Thomas Bessede, Stéphane Droupy & Gérard Benoît

  2. Urology Department, CHU of Bicêtre, University Paris-Sud, 78 Rue Du Général Leclerc, Le Kremlin Bicêtre, 94270, France

    Ayman Awad, Thomas Bessede, Stéphane Droupy & Gérard Benoît

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  1. Ayman Awad
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  2. Bayan Alsaid
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  3. Thomas Bessede
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  4. Stéphane Droupy
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  5. Gérard Benoît
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Correspondence to Ayman Awad.

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Awad, A., Alsaid, B., Bessede, T. et al. Evolution in the concept of erection anatomy. Surg Radiol Anat 33, 301–312 (2011). https://doi.org/10.1007/s00276-010-0707-4

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