Penile magnification pharmacoarteriography: details of intrapenile arterial anatomy

To establish a base of normality against which state-of-the-art penile arteriograms can be assessed, we analyzed selective magnification penile pharmacoarteriograms from 23 men who were not believed to have arteriogenic impotence. The penile arteries showed no evidence of acquired obstructive disease, and all individuals had had normal sexual function in the recent past. The vascular patterns were highly variable and frequently differed from classic descriptions found in textbooks of anatomy. Normal variations that could be easily confused with arterial obstruction were unilateral origin of all cavernosal branches, unilateral hypoplasia of a dorsal penile artery, and aberrant origin of bulbar or cavernosal arteries. Multiple potential collateral routes were shown, including transverse collaterals at the root of the penis and communications between cavernosal and dorsal penile arteries. Appreciation of the type and frequency of anatomic variants and potential collateral routes is important in correctly interpreting penile angiograms and in evaluating the hemodynamic significance of suspected stenoses.