Türk erkeklerinde penil ogmentasyon ve penil ogmentasyonla nörovasküler bantın ilişkisine yönelik anatomik kadavra çalışması

Abstract

BÖLÜM VIIÖZETTÜRK ERKEKLER NDE PEN L OGMENTASYON VE PEN LOGMENTASYONLA NÖROVASKÜLER BANTIN L K S NE YÖNEL KANATOM K KADAVRA ÇALI MASIBu anatomik çalı mada; 50 taze (ölümünden sonra en geç 12 saat içinde) erkek kadavrakullanıldı. Ölçümler, standardizasyonu sa lamak ve hata oranını en aza indirmek için tekki i tarafından ve aynı cetvel kullanılarak kadavralar supin pozisyonda iken yapıldı.Herhangi bir do umsal veya sonradan kazanılmı penis anomalisi saptananlar ve penisleilgili herhangi bir travmatik veya cerrahi prosedür skarı gözlenenler dahil edilmedi.Kadavralar; Grup 1, 40 ya altı (n=23) ve Grup 2, 40 ya üstü (n=27) olarak iki grubaayrıldı. Kadavraların hepsinde; flask ve gerilmi penis uzunlukları, ligamantolizis sonrasıelde edilen kazanç, dorsal penil sinirlerin (DPS) ve dorsal penil venin (DPV) çapı, DPSile DPV arasındaki mesafe ve penil krusların uzunlu u ölçüldü. DPS'in penisdorsumundaki seyri ve penis uzunlu u ile DPS'in çapı arasındaki korelasyonde erlendirildi. Özellikle ligamantolizis gibi penis uzatma yöntemlerinde dikkat edilmesigereken anatomik yapılar gözden geçirildi. Ligamantolizis sonrası elde edilen kazançortalama 37,59 ± 0,50 mm ölçüldü. Ligamantolizis sonrası pubik kemikle penis aftıarasında olu an bo lu a dermo-fat greft, pubik bölgeden planlanan adipofasyal flep veyakostal kartilaj greft gibi otolog dokular yerle tirildi. Özellikle kostal kartilaj greft gibi rijitve otolog bir dokunun kullanılmasıyla ligamantolizis sonrası uzun dönemde ligamentlerinyeniden yapı ması, fibrozisi ve penisin retraksiyonu önlenebilir.Yapılan istatistiksel analizde sadece artan ya la flask penil uzunluk arasında korelasyontespit edildi.51Anahtar Kelimeler: Dorsal penil sinir, penil krus, mikropenis, penis uzatma veogmentasyonu.SECTION VIISUMMARYANATOMICAL CADAVER STUDY OF PENILE AUGMENTATION AND THERELATION OF PENILE AUGMENTATION AND NEUROVASCULAR BUNDLEIn this anatomical study, 50 fresh (latest in 12 hours after death) male cadavers wereused. Measurements were done by the same physician, with the same ruler while thecadavers in supine position, in order to maintain standardization and minimize errors. Thecadavers, which had any congenital or acquired penile anomaly, and any scar related totraumatic and surgical procudure were not included to the study. The cadavers weredivided into two groups were whether they were under 40 years of age (group 1; n=23) orhigher (group 2; n=27). In all the cadavers, flask and streched penile lengths, the gainafter ligamantolysis, the radius of dorsal nerves of penis (DNP) and dorsal penile vein(DPV), distances between DNP and DPV, and the lengths of the penile crura weremeasured. The course of DNP along penile dorsum, and the correlation between thepenile length and the radius of DNP were evaluated. The anatomical structures that needscaution in the penile lengthening procedures, especially in ligamantolysis were observed.In our study the gain after ligamantolysis was observed with a mean of 37,59 ± 0,50 mmin flaccid state. For the spaces that was formed after ligamantolysis between pubic boneand the penile shaft were placed, the autologous tissues like, either dermofat graft, oradipofasial flap that was planned from pubic region or costal cartilage graft. The longterm results can be optimized, especially by the usage of rigid and autologous structureslike costal cartilage graft, that prevents the fusion and fibrosis of ligaments, and retraction52

Anahtar Kelimeler: Dorsal penil sinir, penil krus, mikropenis, penis uzatma veogmentasyonu.SECTION VIISUMMARYANATOMICAL CADAVER STUDY OF PENILE AUGMENTATION AND THERELATION OF PENILE AUGMENTATION AND NEUROVASCULAR BUNDLEIn this anatomical study, 50 fresh (latest in 12 hours after death) male cadavers wereused. Measurements were done by the same physician, with the same ruler while thecadavers in supine position, in order to maintain standardization and minimize errors. Thecadavers, which had any congenital or acquired penile anomaly, and any scar related totraumatic and surgical procudure were not included to the study. The cadavers weredivided into two groups were whether they were under 40 years of age (group 1; n=23) orhigher (group 2; n=27). In all the cadavers, flask and streched penile lengths, the gainafter ligamantolysis, the radius of dorsal nerves of penis (DNP) and dorsal penile vein(DPV), distances between DNP and DPV, and the lengths of the penile crura weremeasured. The course of DNP along penile dorsum, and the correlation between thepenile length and the radius of DNP were evaluated. The anatomical structures that needscaution in the penile lengthening procedures, especially in ligamantolysis were observed.In our study the gain after ligamantolysis was observed with a mean of 37,59 ± 0,50 mmin flaccid state. For the spaces that was formed after ligamantolysis between pubic boneand the penile shaft were placed, the autologous tissues like, either dermofat graft, oradipofasial flap that was planned from pubic region or costal cartilage graft. The longterm results can be optimized, especially by the usage of rigid and autologous structureslike costal cartilage graft, that prevents the fusion and fibrosis of ligaments, and retraction52of penis. In the statistical analyses, the correlation was observed only with the increasedage and the flask penile length.Key Words: Dorsal nevre of penis, penile crus, micropenis, penile lengthening andaugmentation53