Neurovascular Anatomy of the Penis and Pelvis in Thai Males: Applications to Male-to-Female and Pelvic Surgeries
Tanvaa Tansatit MD*, Sirachai Jindarak MD**, Pichet Sampatanukul MD***, Thanakul Wannaprasert MSc****
Affiliation : * Department of Anatomy, Faculty of Medicine, Chulalongkorn University ** Department of Surgery, Faculty of Medicine, Chulalongkorn University *** Department of Pathology, Faculty of Medicine, Chulalongkorn University **** Department of Biology, Faculty of Science, Chulalongkorn University
Objective : To determine the neurovascular profiles in the pelvis and penis for applying to sex reassignment
surgery.
Materials and Methods : Dissection of the pelvis and penile shaft was performed in 12 soft-preserved and 32
fresh adult male cadavers respectively. The neurovascular structures were located and documented, and the
distances between anatomical landmarks were measured. Thirty-two specimens from the glans penis were
obtained for immunohistochemical analysis to analyze its innervation and blood supply.
Results : Several anatomical variations of penile arterial supply were found. They are the presence of the
accessory pudendal artery, multiple cavernous and bulbourethral arteries. The unilateral dorsal artery was
observed in 10 of 32 cadavers, predominantly on the left. From the root to the neck of the penis, the dorsal
nerves were divided into two groups. The first group of fibers innervating the glans coursed along the dorso-
lateral surface of the shaft and pierced the entire area of the corona. The other group diverged to distribute
throughout the lateral surface to innervate the lateral and ventral portions. The mean distance between the
left and right medial main branches that terminated in the glans was 1.18 cm. Immunohistochemical analysis
revealed that the main nerves, after entering the glans, divided into terminal branches that concentrated
around urethra. A mean distance from the main nerves to the epithelium was 0.71 cm.
Conclusion : This detailed anatomy in the pelvis and along the penis should provide a valuable guide for sex
reassignment surgery and intrapelvic operations.
Keywords : Neurovascular anatomy, Penis, Sex reassignment surgery, Pelvic surgery
