(174) Cadaveric Anatomical Description of the Penile Suspensory Apparatus

Abstract Introduction The penile suspensory apparatus, including the fundiform ligament and penile suspensory ligament (PSL), is crucial for maintaining the penis's prepubic curvature and stabilizing erections. PSL dissection is a key component in penile lengthening surgery for micropenis. However, there is limited consensus on the anatomy of the penile suspensory apparatus regarding its form, origin, and insertion. Objective This study aims to describe the apparatus in detail, focusing on its origin, insertion, size, shape, and vascular relations. Methods Thirty-four male pelvic and perineum regions from embalmed cadavers were dissected layer by layer from the abdominal wall to the penile base. The fundiform and penile suspensory ligaments were identified, and their anatomy, including origin, insertion, morphology, and vascular structures, was recorded. Results This study identifies six distinct shapes of the fundiform ligament, with the double structure being the most prevalent, followed by the triangular shape. Other variations included the Y shape, quadrangular shape, double structure with an accessory bundle, and double structure with a median ligament. The majority of fundiform ligaments originated from the linea alba, while some were derived from the Scarpa fascia. All fundiform ligaments inserted into superficial fascia of the penis. The mean length of the left and right fundiform ligament was 9.2 ± 1.8 cm, and 9.3 ± 1.8 cm, respectively. The external pudendal artery was present near the fundiform ligament's insertion point in 55.9% of cases. In contrast, the penile suspensory ligament (PSL) has a triangular structure, comprising three sides with a mean length of 2.7 ± 0.6 cm for the pubic side (PSLP), 2.2 ± 0.6 cm for the penile shaft side (PSLS), and 2.6 ± 0.5 cm for the free margin (PSLF). The angle between PSLP and PSLS averaged 58.6° ± 9.7°. In all cases, the PSL originated from the pubic symphysis and inserted into the deep fascia of the penis. The deep dorsal vein was identified in 52.9% of cases. Conclusions This research is the first to measure all three sides of the penile suspensory ligament (PSL) and the angle between the PSLP and PSLS. The diversity in fundiform ligament shapes and origins highlights the structure’s complexity, indicating a need for individualized surgical planning. Moreover, the presence of the external pudendal artery and deep dorsal vein underscores the importance of caution during surgeries involving these structures.The anatomical insights from this study enhance the understanding of the penile suspensory apparatus, particularly its structural variations, origins, and relationships with nearby vascular elements. These findings are crucial for penile lengthening surgery. Disclosure No