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Editorial Comment

Published:November 13, 2013DOI:https://doi.org/10.1016/j.urology.2013.07.076
      This is a very important study on the anatomy of the dorsal nerves and its branches. The branches emerging from the main trunks perforating the tunica albuginea into cavernous tissue were observed in 72.7% of cases, and in 27.3%, no perforating branches could be identified. These findings should be evaluated clinically in physiologic studies in the future for a better dissection and elevation of the neurovascular bundle (NVB) in reconstructive surgery.
      Lateral branches were more often at the proximal shaft (77%-86%) than at the distal shaft (19%-23%) suggesting that it is relevant during NVB dissection to preserve the lateral branches not only on the distal shaft but also on the proximal shaft.
      The preservation of distal and proximal lateral branches during NVB dissection should be mandatory to maintain ejaculatory function and probably to preserve erectile function. The distal dissection of the NVB by everting the glans and preservation of lateral branches should be recommended.
      According to the distribution of anastomosing nerve branches at the dorsal side of the penis, it is recommended that the dissection of the NVB should not be performed through a midline incision and removal of the deep dorsal vein, because this may cause additional trauma to the branches of the NVB. The dissection of the NVB by 2 paraurethral incisions on Buck's fascia seems to be the most effective way to preserve the anatomic distribution of the NVB.
      • Egydio P.H.
      • Lucon A.M.
      • Arap S.
      Treatment of Peyronie's disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft.
      • Egydio P.H.
      • Lucon A.M.
      • Arap S.
      A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles.

      Egydio PH, Kuehhas FE. Distal penile shaft reconstruction and reinforcement: the “Double-Windsocks” technique [e-pub ahead of print]. J Sex Med. doi:10.1111/jsm.12263, accessed August 23, 2013.

      References

        • Egydio P.H.
        • Lucon A.M.
        • Arap S.
        Treatment of Peyronie's disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft.
        Urology. 2002; 59: 570-574
        • Egydio P.H.
        • Lucon A.M.
        • Arap S.
        A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles.
        BJU Int. 2004; 94: 1147-1157
      1. Egydio PH, Kuehhas FE. Distal penile shaft reconstruction and reinforcement: the “Double-Windsocks” technique [e-pub ahead of print]. J Sex Med. doi:10.1111/jsm.12263, accessed August 23, 2013.

      Linked Article

      • Anatomy of the Dorsal Nerve of the Penis, Clinical Implications
        UrologyVol. 83Issue 1
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          To show the branching patterns and the anatomic variations of the dorsal nerve of the penis (DNP) along the penile shaft, particularly the relation with the tunica albuginea.
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        UrologyVol. 83Issue 1
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          We thank Dr. Egydio for his comments. These are the findings of a cadaveric anatomic study and need to be supported with animal models that electrophysiologically investigate the role of these perforating branches inside the corpora cavernosa, as we have mentioned in our study. We are currently planning and working on the setup of the animal model on this topic. We believe that after the verification of the role of these perforating fibers on the hemodynamic process inside the corpora cavernosa, the procedure of elevation of the neurovascular bundle might need some modifications, and a recommendation about the safest route to reach the dorsal aspect of the tunica albuginea will be more valid.
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