Identification of communicating branches among the dorsal, perineal and cavernous nerves of the penis.
Identification of communicating branches among the dorsal, perineal and cavernous nerves of the penis.
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DOI：
10.1097/01.ju.0000072061.84121.7d
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发表时间：
2003-07
期刊：
影响因子：
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通讯作者：
S. Yucel;L. Baskin
中科院分区：
文献类型：
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作者：
S. Yucel;L. Baskin
目的：人类勃起的机制需要一个完整的神经系统的协调，包括阴茎的海绵状神经、会阴神经和背神经。我们使用特异性神经元免疫组化染色和三维重建成像技术确定了这3条神经在耻骨弓下的交流。材料与方法采用免疫组化技术对18例妊娠17.5 ~ 32周的正常人胎阴茎标本进行研究。通过对神经元标记物S-100、神经元一氧化氮合酶（nNOS）、囊泡乙酰胆碱转运蛋白（VAChT）、降钙素基因相关肽和p物质的抗体染色，观察到耻骨弓下前列腺背神经维管束的延续。两个不同的神经束被确定在尿道上方和脚肌起源的内侧。在阴茎门处可见神经束与躯体相连。近阴茎门部背侧神经仅S-100和VAChT染色。从门部脚体交界处到龟头，阴茎背神经纤维S-100、VAChT和nNOS染色阳性。降钙素基因相关肽和P物质在远端神经呈阳性染色，特别是在龟头。海绵体神经全程S-100和nNOS染色。在阴茎门部耻骨弓下发现海绵神经将nNOS阳性分支传递到背神经，使其免疫反应性转变为nNOS阳性。会阴神经近端nNOS阴性，远端nNOS染色阳性。nNOS阳性背神经分支与会阴神经的相互作用发生在海绵体-海绵体交界处，即球海绵体肌的终点。结论在阴茎门处，在肉体开始分离的地方，海绵神经发送nNOS阳性纤维与阴茎背神经连接，从而改变了阴茎远端背神经的功能特征。同样，来自阴部神经的nNOS阴性、腹侧的会阴神经在海绵体-海绵体交界处产生nNOS反应。这两个例子的多余的神经线路在阴茎可能会影响勃起功能，特别是在重建手术。
PURPOSE The mechanism of human erection requires the coordination of an intact neuronal system that includes the cavernous, perineal, and dorsal nerves of the penis. We defined the communication of these 3 nerves that travel under the pubic arch using specific neuronal immunohistochemical staining and 3-dimensional reconstruction imaging technique. MATERIALS AND METHODS A total of 18 normal human fetal penile specimens at 17.5 to 32 weeks of gestation were studied by immunohistochemical techniques. Serial sections were stained with antibodies raised against the neuronal markers S-100, and neuronal nitric oxide synthase (nNOS), vesicular acetylcholine transporter (VAChT), calcitonin gene-related peptide and substance P. RESULTS The continuation of the dorsal neurovascular bundle of the prostate was documented under the pubic arch. Two distinct nerve bundles were identified superior to the urethra and medial to the origin of the crural bodies. Nerve bundles were observed to join the corporeal bodies at the penile hilum. Proximal to the penile hilum the dorsal nerves stained only for S-100 and VAChT. From the junction of the crural bodies at the hilum to the glans penis dorsal nerve fibers stained positive for S-100, VAChT and nNOS. Calcitonin gene-related peptide and substance P demonstrated positive staining at the distal nerves, particularly at the glans. In contrast, the whole course of the cavernous nerve stained for S-100 and nNOS. Under the pubic arch at the penile hilum the cavernous nerves were found to convey nNOS positive branches to the dorsal nerve to transform its immunoreactivity to nNOS positive. Proximal nNOS negative perineal nerves were shown to stain positive for nNOS distal on the penis. Interaction between nNOS positive dorsal nerve branches and perineal nerves was at the cavernous-spongiosal junction, where the bulbospongiosus muscle terminates. CONCLUSIONS At penile hilum, where the corporeal bodies start to separate, the cavernous nerve sends nNOS positive fibers to join the dorsal nerve of the penis, thereby, changing the functional characteristics of the distal penile dorsal nerve. Similarly the nNOS negative, ventrally located perineal nerve originating from the pudendal nerve becomes nNOS reactive at the cavernous-spongiosal junction. These 2 examples of redundant neuronal wiring in the penis may impact erectile function, especially during reconstructive surgery.