What is it about?
This study investigates the anatomy responsible for maintaining an erection and the potential dangers of using electrocautery (a heated surgical tool) during penile surgery. Researchers conducted experiments on human cadaver penises to determine how the penile tissue reacts to electrical burns at different internal pressures. +1 The results showed that when the internal pressure of the penis was low (similar to a flaccid state), electrocautery caused significant damage and fibrosis to the delicate inner erectile tissue (the sinusoids). However, when the pressure was high (simulating a rigid erection above 125 mmHg), the outer layer of the penis—specifically the outer longitudinal layer of the tunica albuginea—acted as a firewall, blocking the heat and protecting the inner tissue. This confirms that this outer layer is the specific structure responsible for the "veno-occlusive mechanism," which traps blood inside the penis to maintain rigidity.
Featured Image
Photo by Europeana on Unsplash
Why is it important?
This research addresses a major cause of erectile dysfunction (ED) following penile surgery. Historically, surgeries to repair penile veins have had poor outcomes, often attributed to insufficient treatment or surgical damage. This study provides physical evidence that using electrocautery to seal veins can burn through to the corpora cavernosa, destroying the tissue necessary for future erections. +2 The findings suggest a critical shift in surgical technique: Anatomical Understanding: It pinpoints the outer tunica albuginea as the essential gatekeeper for erection maintenance. Surgical Safety: It strongly advises surgeons to avoid using electrocautery on deep penile veins. Instead, surgeons should use suture ligation (tying veins with thread), which does not cause thermal damage to the erectile tissue. +3
Perspectives
Geng-Long Hsu (Author): "For over a decade, we have observed that electrocautery is a major contributor to the deterioration of erectile function after penile reconstruction, yet scientific evidence was lacking. By using a hemodynamic model, we proved that the delicate inner tissues of the penis are vulnerable to thermal injury unless the penis is in a rigid state. This confirms our hypothesis that the outer tunica acts as a shield. To ensure patient safety and preserve sexual function, we believe surgeons must abandon electrocautery for venous closure and adopt microsurgical ligation." +3
Professor Geng-Long Hsu
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology
Geng-Long Hsu (Author): "For over a decade, we have observed that electrocautery is a major contributor to the deterioration of erectile function after penile reconstruction, yet scientific evidence was lacking. By using a hemodynamic model, we proved that the delicate inner tissues of the penis are vulnerable to thermal injury unless the penis is in a rigid state. This confirms our hypothesis that the outer tunica acts as a shield. To ensure patient safety and preserve sexual function, we believe surgeons must abandon electrocautery for venous closure and adopt microsurgical ligation." +3
Dr. Geng Long Hsu
Read the Original
This page is a summary of: Reply, Urology, December 2015, Elsevier,
DOI: 10.1016/j.urology.2015.07.056.
You can read the full text:
Contributors
The following have contributed to this page
