Anatomical peripheral vasculonervous pathways of erectile function.

Thanks to immunohistochemical research techniques and computer-assisted dissection, the anatomical knowledge of the vascular and peripheral nervous erectile pathways is becoming clearer. Although deep penile vascularisation is mainly dependent on the internal pudendal artery, additional supply may be provided by an accessory pudendal artery originating from a vesical or obturator artery. The penile arterial network comprises four main longitudinal axes, which communicate by two types of anastomosis: superficial extra-albugineal and deep trans-albugineal. These vascular pathways are accompanied and innervated by nervous communications between the infralevator somatic system and the supralevator autonomic system. These communications occur at three levels: proximal (translevator), intermediate (hilar) and distal (intrapenile). The distribution of neurotransmitters in the cavernous compartment makes it possible to distinguish a proximal segment with autonomic dominance, particularly nitrergic, which ensures penile rigidity, and a distal segment with somatic dominance, which ensures sensitivity.