成人和大鼠阴茎包皮及包皮系带内降钙素基因相关肽免疫阳性神经末梢的分布及来源

目的探讨人和大鼠阴茎包皮和包皮系带内降钙素基因相关肽（CGRP）免疫阳性神经末梢的分布和起源。方法采用免疫组织化学法观察成人阴茎包皮和包皮系带内CGRP免疫阳性神经末梢的分布,通过荧光金（FG）逆行标记和CGRP免疫荧光标记相结合法研究大鼠包皮系带内CGRP免疫阳性神经末梢的起源。结果成人阴茎包皮及包皮系带内均有CGRP免疫阳性神经末梢存在,主要位于表皮基底层和棘细胞层内,呈树枝状或念珠状分布,大多成束走行。阴茎系带处CGRP免疫阳性神经末梢的分布密度明显大于阴茎包皮处。大鼠的阴茎包皮和包皮系带内也有类似的CGRP免疫阳性神经末梢分布,结合FG逆行标记法研究发现,神经末梢起源于第6腰髓对应的背根神经节（L6-DRG）和第1骶髓对应的背根神经节（S1-DRG）的神经元。CGRP免疫荧光标记细胞大多为中小型,呈深绿色,沿神经束成行排列或散在分布。FG／CGRP双标阳性细胞均为中小型,其数量占FG逆标阳性细胞总数的二分之一。结论人和大鼠阴茎包皮及包皮系带内存在着大量的CGRP免疫阳性神经末梢;大鼠实验表明,这些末梢来源于L6-DRG和S1-DRG,提示CGRP可能参与阴茎包皮及包皮系带感觉信息的传递。     

成人阴茎包皮及包皮系带内nNOS免疫阳性神经末梢的分布

目的：观察成人阴茎包皮与包皮系带内神经元型一氧化氮合酶（nNoS）免疫阳性神经末梢的分布。方法：免疫组织化学方法。结果：正常成人阴茎包皮及包皮系带内均有密集的nNOS免疫阳性神经末梢存在,这些神经末梢主要位于表皮基底层,呈树枝状或念珠状分布,大多成束走行。阴茎系带处nNOS免疫阳性神经末梢的分布密度明显大于阴茎包皮处。结论：一氧化氮（NO）参与了阴茎包皮及包皮系带感觉信息的传递。     

隐匿型阴茎的外科治疗(附8例报告)

隐匿型阴茎是一种阴茎体发育正常,但显露异常的先天性疾病,患儿多伴有肥胖.手术方式较多,临床上多采用Devine术式,因其可能出现术后包皮仍过长特别是系带处臃肿,以及可能误伤阴茎背动脉、神经,疗效欠佳.我科自2005年以来收治8例,均行手术治疗,疗效满意.现报道如下.……     

猫阴部神经传入传出成分在脊髓内的定位分布—HRP逆行及跨越神经节追踪研究

向猫阴部神经及其分支注入HRP溶液,观察并分析了逆行和跨节追踪的结果。 1.证实阴部神经为含躯体传出、传入,内脏传出、传入纤维的混合神经,其内脏性传出、传入成分仅存在于阴茎背神经中。 2.逆行标记细胞出现于L_7—S_3前角Onuf核和S_(1-3)的中间带外侧核。本文结果表明,Onuf核是支配盆底横纹肌的运动核,但它和其它前角运动核在细胞形态和活性物质的分布上都明显不同。特别是它的一部分神经元的树突形成树突束到达中间带外侧核。本文结合排尿、排便功能从形态学上较详细地讨论了Onuf核和中间带外侧核的关系。 3.本文证明阴部神经领域的内脏初级传入(来自阴茎背神经)和躯体初级传入纤维都向骶髓后连合核区有浓密的投射。结合以往的工作讨论了盆腔脏器、外生殖器的内脏传入和坐骨神经、阴部神经的躯体传入在骶髓后连合核区汇聚的现象及机能意义,推测这种汇聚可能是产生牵涉痛和针刺镇痛机制的形态学基础。     

阴茎皮肤和包皮动脉的应用解剖

目的：为带蒂阴茎皮瓣修复尿道下裂提供解剖学基础。方法：对３０例成年男性阴茎的动脉分布进行解剖观察。结果：阴茎背浅动脉的一级分支集中在阴茎的近、中１／３段内，其再分支呈扇形分布于阴茎皮肤和包皮。阴茎背浅动脉的分支首先进入包皮外板，经包皮内外板交界处，返折进入内板。阴茎背浅动脉有三种配布类型：①单支分布型（３０％）；②对称分布型（４０％）；③非对称分布型（３０％）。阴茎背动脉在距阴茎冠状沟０．５～１．５ｃｍ范围内发出穿支至包皮内板。结论：用阴茎远侧皮肤和包皮作纵行带蒂岛状皮瓣具有可行性。     

脑血管的肽能神经支配

<正> 传统认为,脑血液循环的调节有4种机制参与,即化学调节、代谢调节、机械调节及神经调节。其中,神经调节机制的发现经历了较长一段时间,十九世纪后叶,Willis发现大脑前、后动脉有神经纤维分布,不久,Benedikt及Aronsone报告这些脑血管上的神经纤维可能来自颈交感丛。1967年,Nielsen和Owman~(23)发现脑血管的各个部分都有密集的含去甲肾上腺素神经纤维分布,至此脑血管神经支配的概念才真正得以建立。     

改良袖套式包皮环切术治疗包皮过长28例报告

目的探讨改良袖套式包皮环切术治疗包皮过长患者的疗效。方法采用改良袖套式包皮环切术治疗包皮过长患者28例。术中先标志包皮切除长度,在直视下于包皮内、外板作两个互相平行的环形切口,将两切口间包皮条用小圆头刀锐性剥离,保留完整肉膜及皮下浅层血管,并保留完整的包皮系带。结果28例术中出血极少,切口整齐,术后伤口无水肿,无继发性出血及感染,均一期愈合,切口瘢痕少,阴茎外形美观。结论改良袖套式包皮环切术对包皮过长患者治疗效果满意。     

人和大鼠输精管平滑肌和神经的形态学研究

本实验用组织化学、电镜和生化测定方法研究了人和大鼠输精管的平滑肌和神经分布。结果表明;大鼠输精管的神经密度明显高于人,轴索数/100个肌细胞断面,大鼠是118,人是315肌-神经间隔,大鼠是25nm左右,人是100nm左右;肌细胞外间隙(％),大鼠是12.9,人是35.8;肾上腺素能神经支配占优势,乙醛酸诱发荧光法显示大鼠输精管肌层内有致密的肾上腺素能神经纤维,ACh阳性反应神经较少,主要分布于固有层,人输精管中上述两种神经均较少;每克湿组织中NE含量(ng)大鼠约为人的10倍左右(大鼠:2369.35±820.27,人:294.66±83.90);电镜观察,SGV型神经终末支多见。     

阴茎勃起神经与神经性勃起功能障碍

阴茎勃起受周围神经的调节,包括植物神经(交感神经和副交感神经)及躯体神经(感觉和运动神经),植物神经与躯体神经之间存在广泛的交通支,它们在阴茎勃起的调控中起重要作用。临床及法医学工作中常遇到因阴部神经和/或海绵体神经损伤而导致阴茎勃起能力减退或消失的患者。因此,正确理解阴茎的神经分布以及上述神经损伤与男子性功能障碍之间的关系对神经性勃起功能障碍的诊治十分关键。     

女性乳房深部神经的走行分布及其临床意义

目的:研究女性乳房深部神经的走行分布,为设计合理的乳房缩小整形术式提供解剖学基础。方法:对7具女性尸体的14个乳房标本的肋间神经分支进行解剖观测,其中3具为乳房肥大伴下垂标本。结果:第4肋间神经外侧皮支的深支恒定到达乳头乳晕,于乳房后间隙向内走行约(2.8±1.0)cm后进入乳腺,距乳晕缘(2.2±1.3)cm穿出乳腺,于皮下走行进入乳晕皮下;在下垂乳房,该神经随乳房下垂而下降。3、5肋间神经深支到达乳晕者分别为2个乳房和4个乳房。前皮支没有深支进入乳腺。结论:乳头乳晕总是恒定地接受来自第4肋间神经外侧皮支深支的神经支配,因此在乳晕周围环形切口乳房缩小整形术中,在皮下浅支均被切断的情况下,应最大限度地保留外下方腺体携带乳头乳晕转移,以保证乳头乳晕的感觉。     

The ischiourethralis muscle of the rat: anatomy, innervation, and function

The ischiourethralis (IU), a striated perineal muscle presumed to be involved in sexual reflexes, was studied in the rat. The paired muscle arises from the penile crus and the penile bulb and unites in a raphe over the deep dorsal vein of the penis. Retrograde tracing studies show that the muscle is innervated by neurons in the dorsolateral nucleus of the lumbar spinal cord, a pudendal nerve motor nucleus which also innervates the ischiocavernosus muscle. Excision of the IU muscle did not interfere with the ability of males to display normal copulatory behavior, nor did it affect significantly the number and intensity of reflexive erections. It nevertheless remains possible that the IU may contribute to intense glans erection by compressing the deep dorsal vein.     

Caverno-pudendal nervous communicating branches in the penile hilum

Classically, the peripheral neural pathways for erection are proerectile, issuing from the parasympathetic sacral fibres, and antierectile from the thoracolumbar sympathetic trunk. The cavernous nerves as terminal branches of the pelvic plexus convey the parasympathetic fibres to the penis. The pudendal nerve conveys sensory fibres from the penis and somatic fibres to the bulbospongiosus and ischiocavernosus striated mm. In animals, it has been demonstrated that the dorsal nerve of the penis contains sympathetic fibres. These findings suggest that communicating branches exist between the cavernous nerves and the dorsal nerve. Our aim in this study was to demonstrate the presence of such connections in man. We dissected 20 fresh male cadavers. The pelvic plexus and pudendal nerves were dissected to identify their terminal branches and connections. Histologic study was performed. Our results showed evidence of communicating nervous branches between the cavernous nerves and the dorsal nerve of the penis. Several variants existed concerning the number and type of connections. The presence of such communicating branches proves that the supralevator and infralevator neural pathways communicate and suggest the possibility of a kind of plasticity of the nervous supply of penile erection. Further studies are needed to identify the nature of these communicating branches.     

Correlation Between the Distribution of SP and CGRP Immunopositive Neurons in Dorsal Root Ganglia and the Afferent Sensation of Preputial Frenulum

The aim of this study was to explore the distribution of substance P (SP) and calcitonin gene‐related peptide (CGRP) immunoreactive nerve terminals in the penis prepuce and the preputial frenulum. The possible correlation between SP‐ and CGRP‐immunopositive neurons in dorsal root ganglia (DRG) and the afferent sensation of the penile preputial frenulum is also discussed. Immunohistochemistry showed SP‐ and CGRP‐positive nerve terminals in the epidermal basal layer of the prepuce and frenulum in adult human males. The majority of the nerve terminals presented as bundles of different lengths and a few as enlarged nodosities. The density of SP‐ and CGRP‐immunopositive nerve terminals in the preputial frenulum was significantly higher than those in the penis prepuce (P<0.01). Fluoro‐Gold (FG) retrograde tracing method was used to trace the origin of nerve terminals in Sprague‐Dawley rats. SP and CGRP immunofluorescence labeling was employed to detect the distribution of SP‐ and CGRP‐immunoreactive neurons in DRG. FG retro‐labeled neurons were localized in L₆‐DRG and S₁‐DRG. All the FG/SP and FG/CGRP double‐labeled neurons were medium or small‐sized. One‐third of the FG‐labeled neurons were SP‐immunoreactive, and a half of them CGRP‐immunoreactive in L₆‐DRG and S₁‐DRG, respectively. The FG/SP/CGRP‐labeled neurons accounted for one fifth of the FG retro‐labeled neurons. Taken together, these data suggest that the SP‐ and CGRP‐immunopositive nerve fibers may participate in the transmission of afferent sensation in the preputial frenulum. Anat Rec, 2011. © 2010 Wiley‐Liss, Inc.     

Autonomic-somatic communications in the human pelvis: computer-assisted anatomic dissection in male and female fetuses

Sphincter continence and sexual function require co-ordinated activity of autonomic and somatic neural pathways, which communicate at several levels in the human pelvis. However, classical dissection approaches are only of limited value for the determination and examination of thin nerve fibres belonging to autonomic supralevator and somatic infralevator pathways. In this study, we aimed to identify the location and nature of communications between these two pathways by combining specific neuronal immunohistochemical staining and three-dimensional reconstruction imaging. We studied 14 normal human fetal pelvic specimens (seven male and seven female, 15-31 weeks' gestation) by three-dimensional computer-assisted anatomic dissection (CAAD) with neural, nitrergic and myelin sheath markers. We determined the precise location and distribution of both the supra- and infralevator neural pathways, for which we provide a three-dimensional presentation. We found that the two pathways crossed each other distally in an X-shaped area in two spatial planes. They yielded dual innervation to five targets: the anal sphincter, levator ani muscles, urethral sphincter, corpus spongiosum and perineal muscles, and corpora cavernosa. The two pathways communicated at three levels: proximal supralevator, intermediary intralevator and distal infralevator. The dorsal penis/clitoris nerve (DN) had segmental nitrergic activity. The proximal DN was nNOS-negative, whereas the distal DN was nNOS-positive. Distal communication was found to involve interaction of the autonomic nitrergic cavernous nerves with somatic nitrergic branches of the DN, with nitrergic activity carried in the distal part of the nerve. In conclusion, the pelvic structures responsible for sphincter continence and sexual function receive dual innervation from the autonomic supralevator and the somatic infralevator pathways. These two pathways displayed proximal, intermediate and distal communication. The distal communication between the CN and branches of the DN extended nitrergic activity to the distal part of the cavernous bodies in fetuses of both sexes. These structures are important for erectile function, and care should therefore be taken to conserve this communication during reconstructive surgery.     

Sulcus nervi dorsalis penis: site of origin of Alcock's syndrome in bicycle riders?

This article introduces a hypothesis that the pudendal nerve compression syndrome, also known as the Alcock's syndrome in long-time duration bicycle riders might be caused by an irritation of the dorsal nerve of penis in a groove on the inferior ramus and the anterior surface of pubis, previously described by authors as the sulcus nervi dorsalis penis. Alcock's syndrome in bicycle riders has been characterized as a prolonged glans and penile insensitivity, genital numbness and an erectile dysfunction. Although no anorectal pain or disturbance of the bulbocavernosus reflex has been reported in these patients, we assume it cannot be caused by a compression of the pudendal nerve in pudendal (Alcock's) canal, hence by a compression of the dorsal nerve of penis in the sulcus nervi dorsalis penis. In future, if clinical studies confirm our hypothesis, it might be more sophisticated to evaluate this syndrome apart from the Alcock's syndrome and term it the dorsal nerve compression syndrome rather than the Alcock's syndrome.     

Innervation of the anterior perineal muscles and its morphological consideration

3 male and 3 female pelvic-halves were dissected carefully under a stereomicroscope in order to obtain more detailed data on the nerve supply to the anterior perineal muscles. At its origin from the pudendal plexus, the perineal nerve has a close relationship with the dorsal nerve of the penis or clitoris, while it tends to be separate from the inferior rectal nerve. The ischiocavernosus and the transversus perinei profundus are in general supplied by a common branch which arises from the perineal nerve at the posterior part of the ischiorectal fossa and takes a more lateral course, independent of the cutaneous branches. The bulbospongiosus and the transversus perinei superficialis receive several twigs from the medial and intermediate cutaneous branches of the perineal nerve. From the view point of nerve supply, the anterior perineal muscles may be classified into 2 groups: the lateral group comprising the ischiocavernosus and the transversus perinei profundus, the medial group comprising the bulbospongiosus and the transversus perinei superficialis.     

Effects of dorsal penile nerve transection upon the sexual behaviour of the male marmoset (Callithrix jacchus)

The sexual behaviour of 7 adult male marmosets and their ovariectomized partners was observed during pair-tests before and after bilateral dorsal penile nerve transection (n = 4) or a sham operation (n = 3). After transection of the dorsal penile nerves, males mounted more frequently and the initial mount of each test was more prolonged. Males continued to orientate correctly during mounts and to make rapid pelvic thrusts, with the erect penis close to the vaginal orifice. However, the deep pelvic thrust required to attain intromission was abolished. Intromission was rarely observed postoperatively and ejaculation occurred only twice, in one male. These effects were not observed in sham-operated males. The results show that afferent impulses from the penis, travelling through the dorsal penile nerves, play a vital role in the coordination of intromission and ejaculation in this primate species.     

Neural control of erection

Penile erection is a vascular event controlled by the autonomic nervous system. The spinal cord contains the autonomic preganglionic neurons that innervate the penile erectile tissue and the pudendal motoneurons that innervate the perineal striated muscles. Sympathetic pathways are anti-erectile, sacral parasympathetic pathways are pro-erectile, and contraction of the perineal striated muscles upon activity of the pudendal nerves improves penile rigidity. Spinal neurons controlling erection are activated by information from peripheral and supraspinal origin. Both peripheral and supraspinal information is capable of either eliciting erection or modulating or inhibiting an erection already present. Sensory information from the genitals is a potent activator of pro-erectile spinal neurons and elicits reflexive erections. Some pre-motor neurons of the medulla, pons and diencephalon project directly onto spinal sympathetic, parasympathetic and pudendal motoneurons. They receive in turn sensory information from the genitals. These spinal projecting pathways release a variety of neurotransmitters, including biogenic amines (serotonin, dopamine, noradrenaline, and adrenaline) and peptides that, through interactions with many receptor subtypes, exert complex effects on the spinal network that controls penile erection. Some supraspinal structures (e.g. the paraventricular nucleus and the medial preoptic area of the hypothalamus, the medial amygdala), whose roles in erection have been demonstrated in animal models, may not project directly onto spinal pro-erectile neurons. They are nevertheless prone to regulate penile erection in more integrated and coordinated responses of the body, as those occurring during sexual behavior. The application of basic and clinical research data to treatment options for erectile dysfunction has recently proved successful. Pro-erectile effects of phosphodiesterase type 5 inhibitors, acting in the penis, and of melanocortin agonists, acting in the brain, illustrate these recent developments.