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Complete Penile Corporeal Septation
0022-5347/96/1552-0647$03.00/0
THEJOURNAL OF UROL~CV Copyright 0 1996 by AMERICAN WROLOGICAL ASSOCIATION, INC.
Vol. 155,647.February 1996 Printed in U S A
COMPLETE PENILE CORPOREAL SEPTATION JAY B. HOLLANDER
AND
CHRISTOPHER A. STIFF
From the Department of Urology, William Beaumont Hospltal, Royal Oak.
Mic higari
KEYWORDS penis, penile erection, alprostadil
In man t h e penile corpora cavernosa have vascular continuity via channels passing through t h e penile septum. To our knowledge we report the first case of a complete penile sept u m resulting in corporeal vascular dissociation. The patient presented with primary sexual dysfunction. CASE REPORT
A 38-year-old white man presented with a lifelong history of sexual dysfunction described as erections that were never fully rigid. Sexual intercourse was suboptimal because of buckling of t h e erection. Medical history and physical examination were unremarkable. A Rigiscan* evaluation demonstrated 3 or 4 erectile episodes with reasonable tumescence and duration but rigidity was less t h a n 70%. Injection of 15 mcg. prostaglandin E l into the right corporeal body resulted in full rigidity of the right corporeal body only and left curvature of the penis while the left corporeal body remained flaccid. The left corporeal body was then injected with prostaglandin E l , resulting in a full straight erection that exceeded those previously experienced. Duplex ultrasonography demonstrated unilateral tumescence of the corpora after injection of prostaglandin E l (fig. 1). Cavernosal -arterial flow velocity -was normal and in2. Infusion cavernosogra hy after injection of prostaglandin creased only on t h e injected side. Cavernosography revealed E 1FIG. into left corpora reveals uniPatera1 corporeal opacification. eft unilateral corporeal opacification when contrast medium was became figid and fight corpora remained flaccid. Accepted for publication July 14, 1995. ' Dacomed Corp., Minneapolis, Minnesota
injected, confirming the diagnosis of complete corporeal septation (fig. 2). DISCUSSION
I n man the penile corpora are 2 paired cylinders of spongy vascular tissue contained within a thick tunica albuginea. These corpora separate at t h e crura and meet at the penile portion, where they communicate fieely through a penile septum between the corporeal bodies. In dogs a noncommunicating septum exists through the entire penile length, resulting in independently functioning corpora after injection with vasoactive substances.' In our patient a similar situation existed with a unilateral response to pharmacological injection therapy. Erectile dysfunction in our case may be related to primary corporeal dysfunction, as suggested by the anomalous corporeal septum. To our knowledge we report the first case of complete penile septation in man. Our patient presently has improved sexual function with bilateral intracorporeal pharmacotherapy . REFERENCES
1. Fournier, G. R.. Jr., Jueneman, K.-P., Lue, T. F. and Tanagho, F I ~ ; 1. . After injection of prostaglandin E~ left corpora ( * ) inE. A,: Mechanisms of venous occlusion during canine penile creased to 20 mm. in diameter while 11 mm. right corpora (0) erection: an anatomic demonstration. J. Urol.. 137: 163. 1985. remained flaccid.
645
THEJOURNAL OF UROL~CV Copyright 0 1996 by AMERICAN WROLOGICAL ASSOCIATION, INC.
Vol. 155,647.February 1996 Printed in U S A
COMPLETE PENILE CORPOREAL SEPTATION JAY B. HOLLANDER
AND
CHRISTOPHER A. STIFF
From the Department of Urology, William Beaumont Hospltal, Royal Oak.
Mic higari
KEYWORDS penis, penile erection, alprostadil
In man t h e penile corpora cavernosa have vascular continuity via channels passing through t h e penile septum. To our knowledge we report the first case of a complete penile sept u m resulting in corporeal vascular dissociation. The patient presented with primary sexual dysfunction. CASE REPORT
A 38-year-old white man presented with a lifelong history of sexual dysfunction described as erections that were never fully rigid. Sexual intercourse was suboptimal because of buckling of t h e erection. Medical history and physical examination were unremarkable. A Rigiscan* evaluation demonstrated 3 or 4 erectile episodes with reasonable tumescence and duration but rigidity was less t h a n 70%. Injection of 15 mcg. prostaglandin E l into the right corporeal body resulted in full rigidity of the right corporeal body only and left curvature of the penis while the left corporeal body remained flaccid. The left corporeal body was then injected with prostaglandin E l , resulting in a full straight erection that exceeded those previously experienced. Duplex ultrasonography demonstrated unilateral tumescence of the corpora after injection of prostaglandin E l (fig. 1). Cavernosal -arterial flow velocity -was normal and in2. Infusion cavernosogra hy after injection of prostaglandin creased only on t h e injected side. Cavernosography revealed E 1FIG. into left corpora reveals uniPatera1 corporeal opacification. eft unilateral corporeal opacification when contrast medium was became figid and fight corpora remained flaccid. Accepted for publication July 14, 1995. ' Dacomed Corp., Minneapolis, Minnesota
injected, confirming the diagnosis of complete corporeal septation (fig. 2). DISCUSSION
I n man the penile corpora are 2 paired cylinders of spongy vascular tissue contained within a thick tunica albuginea. These corpora separate at t h e crura and meet at the penile portion, where they communicate fieely through a penile septum between the corporeal bodies. In dogs a noncommunicating septum exists through the entire penile length, resulting in independently functioning corpora after injection with vasoactive substances.' In our patient a similar situation existed with a unilateral response to pharmacological injection therapy. Erectile dysfunction in our case may be related to primary corporeal dysfunction, as suggested by the anomalous corporeal septum. To our knowledge we report the first case of complete penile septation in man. Our patient presently has improved sexual function with bilateral intracorporeal pharmacotherapy . REFERENCES
1. Fournier, G. R.. Jr., Jueneman, K.-P., Lue, T. F. and Tanagho, F I ~ ; 1. . After injection of prostaglandin E~ left corpora ( * ) inE. A,: Mechanisms of venous occlusion during canine penile creased to 20 mm. in diameter while 11 mm. right corpora (0) erection: an anatomic demonstration. J. Urol.. 137: 163. 1985. remained flaccid.
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