ANATOMY OF PENIS AND
ETIOPATHOGENESIS
OF PENILE CANCER
S.SIVAKUMARI
Ist year postgraduate
MCh Surgical Oncology
ANATOMY
penis with the scrotum make up the external
male genitalia
located on the front part of pelvis suspended
from the perineum
Anatomical position
ANATOMY OF PENIS
penile shaft composed of 3 erectile columns
2 corpora cavernosa
corpus spongiosum
enveloping fascial layers, nerves, lymphatics and
blood vessels covered by skin
ANATOMY OF PENIS
ROOT BODY
Attached part Free part
2 crura –proximal part of corpora Formed by tethering of 2
cavernosa fixed to pubic arch proximal free parts of
Bulb–dilated proximal part of corpora cavernosa
corpus spongiosum anchored to
perineal membrane
Corpus spongiosum containing
the urethra
ANATOMY OF PENIS
LIGAMENTS OF PENIS
SUSPENSORY LIGAMENT
attached to pubic symphysis
FUNDIFORM LIGAMENT
more superficial
attached above to linea alba
splits below into 2 bands, pass
either side, unite inferiorly
CORPORA CAVERNOSA
The erectile tissue within the corpora contains arteries, nerves,
muscle fibers, and venous sinuses lined with flat endothelial
cells, and it fills the space of the corpora cavernosa. The cut
surface of the corpora cavernosa looks like a sponge. There is
a thin layer of areolar tissue that separates this tissue from
the tunica albuginea
C/S OF PENIS
TUNICA ALBUGINEA
2 layers
outer longitudinal
inner circular
becomes thicker ventrally where it forms a groove to
accommodate the corpus spongiosum
tunica albuginea of corpus spongiosum is thinner (< 0.5 mm)
than that of the corpora cavernosa (approximately 2 mm)
TUNICA ALBUGINEA
Along the inner aspect of the tunica albuginea, flattened
columns or sinusoidal trabeculae composed of fibrous tissue
and smooth muscle surround the endothelial-lined sinusoids
(cavernous spaces). In addition, a row of structural trabeculae
arises near the junction of the 3 corporal bodies and inserts in
the walls of the corpora about the midplane of the
circumference
TUNICA ALBUGINEA
The corpus spongiosum possesses a much thinner and more elastic
tunica albuginea to allow distention for passage of the ejaculate
through the urethra
also allows the corpus to become less rigid during erection
the distal extension of the spongiosum, the glans penis, covers the
tips of the corpora cavernosa to provide a cushioning effect
The edge of the glans overhangs the shaft of the penis, forming a rim
called corona
The urethral meatus is positioned slightly on the ventral surface of
the glans and is a vertical slit
COVERINGS OF PENIS
The 3 erectile bodies are surrounded by deep penile
(Buck) fascia, the dartos fascia, and the penile skin
BUCK’S FASCIA
The deep penile (Buck) fascia is a strong, deep, fascial
layer that is immediately superficial to the tunica
albuginea. It is continuous with the deep fascia of
the muscles covering the crura and bulb of the penis,
the ischiocavernosus and bulbospongiosus
BUCK’S FASCIA
the deep dorsal vein and paired dorsal arteries and branches of the dorsal
nerves are contained within the deep penile (Buck) fascia
splits to surround corpus spongiosum, and extends into perineum as deep
fascia of ischiocavernosus and bulbospongiosus muscles
encloses these muscles and each crus of the corpora cavernosa and bulb
of the corpus spongiosum, adhering them to the pubis, ischium, and the
urogenital diaphragm
DARTOS FASCIA
subcutaneous connective tissue of penis and scrotum has abundant
smooth muscle and is called the dartos fascia - continues into the
perineum and fuses with superficial perineal (Colle) fascia
In the penis, the dartos fascia is loosely attached to the skin and deep
penile (Buck) fascia and contains the superficial arteries, veins, and nerves
of the penis.
PENILE SKIN
continuous with that of the lower abdominal wall
Distally, it is confluent with the smooth, hairless skin covering
the glans
At the corona, folded on itself to form the prepuce (foreskin),
which overlies the glans
ARTERIES OF PENIS
SKIN External pudental Artery
branch of femoral artery
CORPORA Internal pudental Artery
branch of internal iliac artery
ends as common penile Artery
VASCULAR SUPPLY
Bulbourethral Artery
urethra,spongiosum,glans
Cavernosal Artery- straight &
helicine
corpora cavernosa
Dorsal Artery
dorsal surface of corpora cavernosa
ANOMALOUS ARTERIES
Accessory pudental artery- branch of obturator /
inferior vesical artery
May replace common penile A.
Anterolateral to or within prostate
4% of radical prostatectomies, postoperative potency
VENOUS DRAINAGE
Glans
Dorsal vein of penis
Preprostatic plexus
• Spongiosum
Circumflex vein
Deep dorsal vein
• Cavernous sinus
Emissary vein
Cavernous vein – Internal pudental vein
LYMPHATIC DRAINAGE
Superficial inguinal node
Deep inguinal node
Pelvic nodes
External iliac
Internal iliac
Pudental
Cloquets node
ETIOPATHOGENESIS OF CANCER
PENIS
Phimosis and poor local hygiene
HPV
Number of sexual partners
Tobacco
PHIMOSIS
Neonatal circumcision
Smegma byproduct of bacterial action on
desquamated epithelial cells in preputial sac
HPV
More than 25 types infect genital sites
Associated with 31-63 % penile cancers
HPV 6 & 12 – genital wart nonmetastatic verrucous
cancer
HPV 16, 18, 31 & 33 – in situ & invasive
HPV
Genome encodes
Oncoprotein E6 –complexes with p53
Oncoprotein E7 –binds with Rb protein
Affects cell cycle regulation
OTHER FACTORS
Tobacco products in presence of HPV infection and or
bacteria causing chronic inflammation and malignancy
Penile trauma 18:1 risk
UV radiation and 8 methoxy psoralen UVA photochemo
therapy- 286 times risk
UVB 4.6 fold risk
Lichen sclerosus or Balanitis Xerotica Obliterans 3-9% risk
Modifiable behavior can potentially
prevent
penile cancer
THANK YOU
