Assessing the Feasibility of Penile Transplantation Preparation via Proximal Artery Dissection: Insights from a Cadaveric Study.

Aim: Evaluate the feasibility of harvesting the entire penile structure, including the internal pudendal artery and the external pudendal vessels from their origin.

Methods: A monocentric, prospective, cadaveric study was conducted from November 2023 to January 2024 on five male cadavers. The harvesting aimed to include the entire corpora cavernosa, the urethra up to the sub-prostatic region, the pudendal nerves, the external pudendal arteries and veins to their origins and terminations, and the internal pudendal arteries to their origins. The planned surgical stages included accessing the external pudendal vessels, performing an iliac laparotomy, conducting a pelvic osteotomy, harvesting the internal pudendal artery, and graft explantation.

Results: The external pudendal vessels were successfully and systematically harvested, including a patch of the femoral artery and the great saphenous vein. The bilateral iliac laparotomy allowed for the exposure of the external and then internal iliac vessels, as well as the Retzius space. The osteotomy of the pubic symphysis was necessary to expose the penile arteries. The internal pudendal artery was harvested by taking a patch of the internal iliac artery, opening Alcock's canal, and severing the sacrospinous ligament. The penis was freed by transecting the urethra at the level of the prostatic apex, which also allowed for the identification of the deep dorsal vein.

Conclusion: Our study demonstrates that complete harvesting of the penile structures is feasible and could enhance penile transplantation possibilities while preserving vessels for future phalloplasty procedures.