ABSTRACT
Objective: Albeit current human penile anatomy remains unchanged for three thousand centuries and extensive study has been conducted for many centuries, contemporary penile fibro-vascular anatomy is the presumed work of Da Vinci in Medieval times. Given the fact that anatomical knowledge is rudimentary for every reconstructive surgery and the traditional version inadvertently overlooked many indispensable fibro-vascular structures, should its derived strategies for male potency reconstruction be sustainable? Exemplified, such as two cavernosal veins (CVs), four para-arterial veins (PAVs) between Buck’s fascia and the tunica albuginea, and the outer longitudinal tunica that is the determined architecture of penile morphology and protector for an artificial implant, additionally, could the corporeal-veno-occlusive mechanism be fulfilled if no outer tunica? Therefore we sought to report our innovative penile fibro-vascular assembly and its derived male potency reconstructive strategies including penile corporoplasty (PC), penile venous stripping (PVS), penile augmentation (PA), and penile implant (PI) in the recent three decades.
Materials and Methods: After microsurgical drill on rats and dissecting cadaveric penises for anatomy acknowledgment, penile vascular surgery was first made in National Taiwan University Hospital in 1986 and accumulated 3097 cases of PVS uneventfully with Taiwanese method that granted the US PTO (Patent and Trade Office) patent in 2012, till 2015. Neither a Bovie nor suction apparatus is required because of negligible blood loss in the entire procedure. This PVS accounts for 76 to 132 ligations of the emissary vein closest to the outer tunica and is consequently free from postoperative permanent numbness and irreversible penile deformity that could not be avoided by the traditional method. We found that the have-to-use electrocautery and insufficient venous ligation are the reason for unfavorable surgery in the traditional method across three centuries. Acupuncture-assisted local anesthesia (AALA) has been developed since 1988. An epinephrine-rinsed xylocaine is precisely injected to block the proximal dorsal nerve bilaterally, peri-penile infiltration, and cavernosal nerve block if PI is performed. Outpatient penile corporoplasty is made with a scientific formula in over 600 cases among which 217 men request PVS for penile length elongation till 2019. The patient number of PI was 257 till September 2021. Our PI can negate the so-called smaller and soft glans syndrome, in contrast somewhat enlarging the size of the glans penis. A true PA, increasing the diameter of the corpora cavernosa, is applicable despite it being time-consuming and having technical challenges. We will like to present the surgical Niche of AALA, PVS, PC, PI, and even PA based on the revolutionary penile fibro-vascular assembly being inspired from patients’ queries in daily practice in recent several decades.
Conclusion: We may conclude AALA was practical for varied male potency reconstructive strategies and our De Novo penile fibro-vascular assembly seems the last piece of the puzzle in the entire human cardiovascular system in the human body. In order to provide the most robust evidence (level 1), we are yearning for a randomized controlled clinical trial on this PVS that benefits the most impotent males. Hoping those mature surgeries can be available worldwide.

Keywords: Bi-layered tunica albuginea, erection-related veins, penile fibro-vascular anatomy, corporoplasty, erection restoration, penile implantation, penile venous stripping.

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