Human penile tunica albuginea: Anatomy discovery, functional evidence and role in reconstructive and implant surgery

Geng-Long Hsu^1,3*, Cheng-Hsing Hsieh² and Shyh-Chyan Chen³

¹Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology, 3F 88, Wen-Hu Street, Neihu District, Taipei, Taiwan

²Department of Urology, Taipei Tzuchi Hospital, New Taipei, The Buddhist Tzuchi Medical Foundation; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan

³Department of Urology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan

*Corresponding Author E-mail: genglonghsu@gmail.com, glhsu@ha.mc.ntu.edu.tw;   Phone:   886-2- 87526087;  Fax: 886-2-87975207

Accepted 09 December, 2014

Abstract

In the human penis the corpora cavernosa (CC) is a hydralic system which can anatomically be assorted into the smooth muscle and skeletal muscle components. The former includes CC sinusoids and vasculature while the latter are bulbocavernosus, bulbospongiosus, tunica albuginea (TA) and distal ligament. Rigid erection is a result of interplaying two components via healthy supplying arteries and draining veins. Clinicians believed TA to be a single layer before 1991 when a model of a bi-layered structure was discovered as a 360° complete inner circular layer and a 300° incomplete outer longitudinal layer which is absent bordering the CC and corpus spongiosum. In the erection process the outer longitudinal layer plays a pivotal role in closing the emissary veins, which ascertain veno-occlusive mechanism. Although this peculiar design is considerable for allowing ejaculate passing, it is vulnerable to dilator trauma during penile implantation on the TA without outer longitudinal layer which is responsible for penile morphology and thereafter is the targeted tissue for corporoplasy and sustainable layer for penile prosthesis. Overall this new TA anatomy is prerequisite to surgeon whom is going to carry out penile implant or penile morphologic reconstruction regardless attempting surgery is for patching the shortage side of TA or excising the excessive side of TA.

Keywords: Corporoplasty, distal ligament, penile implantation, penile tunica albuginea