How the tunica albuginea protects erections and why cautery can harm erectile tissue

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The study clarifies a mechanistic risk: thermal injury near emissary veins can produce sinusoidal fibrosis unless the tunica albuginea is pressurized to rigid‑erection levels. Clinicians should interpret this as evidence to minimize electrocautery use during penile vascular and reconstructive procedures and to prioritize techniques that preserve intracavernous tissue integrity.

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The Surgeon's View (Dr. Hsu): This study is a critical warning about the use of energy devices in penile surgery. We demonstrated that the outer longitudinal layer of the tunica albuginea is not just a passive covering; it is the primary mechanical container responsible for compressing the veins and maintaining an erection. When surgeons use electrocautery (Bovie) indiscriminately on the tunica, they burn and destroy these essential elastic fibers. This leads to a man-made venous leak. The takeaway is clear: Electrocautery should be strictly avoided or minimized on the tunica albuginea to preserve the natural veno-occlusive mechanism. The Anatomist's View: This research refines our understanding of the "sandwich" structure of the tunica. It confirms that the outer layer (longitudinal fibers) and the inner layer (circular fibers) have distinct roles. The outer layer is the "strength" layer. If this layer is compromised—whether by surgical burns, trauma, or disease—the compression mechanism fails, and blood escapes, regardless of how healthy the inner tissue is. The Patient's View: "This explains why my erectile function got worse after a different penile surgery where they used a lot of 'burning' to stop bleeding. It validates that the surgical technique matters immensely. It makes me want to find a surgeon who uses cold steel or meticulous dissection rather than just burning through tissue."

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