The existence of three cavernous structures in the anatomy of the penis creates the need for both their separation as well as their functional reunification. The integrative structure that accomplishes this is the penile septum itself. It is formed by joining the circular fibers of the tunica albuginea of the two corpora cavernosa. The septum does not have the appearance of a complete wall, but on the contrary, it has a fenestrated appearance 5 [6] [7] .
FIGURE 1
In the posterior part, the fenestrations are rarer, and the septum is denser. Structurally, the septum is made up of pairs of chordae tendineae, similar to the chordae tendineae in the heart.
FIGURE 2
They are placed superiorly and inferiorly on two dense connective masses that occupy the triangular space formed by joining the albuginea of the corpora cavernosa 2 4 [8] [9].
FIGURE 3
This is particularly visible on cross-sections through the penile body.
FIGURE 4
The best represented is the connective mass that joins the two corpora cavernosa at the base of the septum, but at the same time, reunites the corpora cavernosa with the dorsal surface of the corpus spongiosum.
FIGURE 5
This connective structure, triangular in cross-section, is actually the main mechanical integrative structure for the three cavernous structures 3. If we make a comparison with the terminology used in the anatomy of the perineum, it is a kind of tendinous center of the penis where all the important connective structures reach.
FIGURE 6
This connective mass extends along the entire length of the penis between the corpora cavernosa and the dorsal surface of the corpus spongiosum. It is crossed by venous structures 1. The dense connective mass in the upper part of the penile septum is not as well represented as the lower connective mass. Through the spaces between the septal tendinous cords, the cavernous tissue makes right-left anastomoses 1 6.
FIGURE 7
Sometimes these transseptal anastomoses are made through venous structures. These anastomoses explain the fact that in dynamics the two corpora cavernosa can evolve simultaneously.
In the width of the septum, among the tendinous cords, we identified small veins with a vertical arrangement [10].
FIGURE 8
From place to place, from the base of the penile septum, tendinous cords that appear to insert on the internal face of the albuginea depart obliquely towards the dorsal surface of the corpora cavernosa. In appearance, these cords seem to strengthen the penile connective complex. In reality, these tendon pillars are too small to hold the albuginea in tension 3 5 8 7 9 [11].
FIGURE 9
At the level of the penis, however, there are other median structures with a right-left separating function. Although there is an impulse to classify them as part of the penile septum, we believe that these structures should be described separately from the pectiniform septum. Thus we describe:
A) Posteriorly, where the roots of the corpora cavernosa diverge, there is a mass of dense connective tissue with a right-left separating function. This connective mass has had various names over time. In old anatomy books, such as "Traité d'Anatomie humaine' by L. Testut" we find it under the name of the posterior intercavernous transverse ligament [12] .
FIGURE 10
This “ligament” attaches the bulb of the penis to the corpora cavernosa and is basically a continuation of the tendinous center between the roots of the two corpora cavernosa. Other authors call this connective mass the "hilum of the penis" 6 [13] [14] because it is traversed by the cavernous vessels on their way to the corpora cavernosa. However, this connective mass may be very well considered as a posterior segment of the penile septum in its entirety.
In the context of the description of the local anatomy, we draw attention to how the roots of the cavernous bodies are fixed to each other by the intercavernous ligament and then adhere to the lateral faces of the anterior end of the spongy bulb 12.
FIGURE 11
Basically, the corpora cavernosa, the roots of the corpora cavernosa and the bulbus spongiosum at the base of the penis are united by the transverse intercavernous septum, and in its continuation, by fibrous insertions of the roots of the corpora cavernosa.
B) At the level of the gland, the glandular septum has been previously described by some authors [15] . The descriptions, however, are not convincing enough. In the “Traité d'Anatomie humaine” by L. Testut a structure of dense connective tissue called the transverse intercavernous ligament (anterior) is described in the glans penis, superior to the urethra and between the anterior extremities of the corpora cavernosa 12.
In the same region, Geng-Long Hsu 5 describes a variable sagittal septum on the midline above the glandular urethra. He also hypothesizes that these structures originate from the longitudinal fibers of the albuginea of the corpora cavernosa. According to our observations, none of the opinions are completely true to reality. We identified connective masses in the thickness of the supra-urethral gland with variable appearances, dispositions and sizes. We cannot consider these connective structures as septal.
FIGURE 12