Functional and radiologic evidence of vascular communication between the spongiosal and cavernosal compartments of the penis

Objectives. To investigate the possible communication of the glans penis and corpus spongiosum with the corpora cavernosa. Methods. We performed a functional and anatomic study in men with erectile dysfunction. The functional study consisted of the injection of alprostadil (10 to 20 mu g) into the glans in 17 men while recording intracavernosal pressure (ICP). Once the ICP response had stabilized, patients received a second injection of alprostadil by direct intracavernosal (IC) administration. For the anatomic study, a spongiogram was performed in 5 patients by the injection of radiologic contrast into the glans. Results. Injection of alprostadil into the glans caused tumescence of the glans and corpus spongiosum, followed by tumescence of the corpora cavernosa with an increase in ICP from 9 +/- 2 mm Hg (mean +/- SD) at baseline to a peak response of 50 +/- 25 mm Hg. Subsequent IC injection of alprostadil, on average, increased ICP by only 5 mm Hg (a 15% increase) above the response to injection in the glans. The spongiogram demonstrated drainage of the glans into the deep dorsal vein, as well as drainage of the spongiosum into the circumflex veins, which in turn drained into the deep dorsal vein. Filling of the corpora was also visualized, suggesting that it occurred in a retrograde manner, through the draining venules. Conclusions. Our study demonstrates that injection of alprostadil into the spongy tissue of the glans can provoke erection of the corpora cavernosa, and that common channels for the drainage of the glans, corpus spongiosum, and corpora cavernosa are most likely the route for drug transfer from the spongiosal to the cavernosal compartment. (C) 1997, Elsevier Science Inc.