What are the arterial, venous, and lymphatic drainage of the penis?

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Penile Vasculature

Arterial Supply

The penis receives its arterial blood supply primarily from the internal pudendal artery, a branch of the anterior division of the internal iliac artery, though significant anatomic variations exist that are clinically important. 1, 2

Primary Arterial Pattern

  • The internal pudendal artery is the major source of penile blood supply in most individuals 2
  • This artery typically divides into terminal branches that supply the erectile tissues and penile structures 2
  • The penis functions as an end-artery organ, making it highly susceptible to peripheral vascular disease 1

Anatomic Variations (Critical for Surgical Planning)

Three distinct patterns of penile arterial supply have been identified through cadaveric studies:

  • Type I (15%): Arterial supply arising exclusively from internal pudendal arteries 3
  • Type II (70%): Combined supply from both accessory pudendal arteries and internal pudendal arteries 3
  • Type III (15%): Supply arising exclusively from accessory pudendal arteries 3

Accessory Pudendal Arteries

  • Accessory pudendal arteries are common anatomic variants that may originate from the inferior vesical, obturator, or external iliac arteries 2
  • These vessels course above the pelvic diaphragm (supralevator pathway) before reaching the penis 2
  • Terminal branches of accessory pudendal arteries primarily supply the corpora cavernosa 3
  • These variations appear to be congenital rather than acquired secondary to atherosclerotic disease 3

Clinical Significance of Arterial Variations

  • Accessory pudendal arteries lie in close proximity to the prostate, creating high risk of injury during radical prostatectomy 3
  • Section of accessory pudendal arteries during pelvic surgery may adversely affect postoperative erectile function 2
  • Anastomoses between supralevator and infralevator arterial pathways are frequent, providing collateral circulation 2

Venous Drainage

While the provided evidence focuses primarily on arterial anatomy and lymphatic drainage, the venous system follows the arterial supply in reverse, draining through the internal pudendal venous system back to the internal iliac veins.

Lymphatic Drainage

The penile lymphatic system demonstrates a complex bilateral drainage pattern with potential for crossover, draining through both superficial and deep inguinal nodes. 4, 5

Lymphatic Drainage Pathways

  • Both superficial and deep lymphatic systems traverse Buck's fascia to reach the presymphyseal lymphatics before entering the inguinal region 4, 5
  • Crossover to contralateral nodes can occur at the presymphyseal lymphatics, allowing bilateral spread 4, 5

Superficial Lymphatic System

  • Drains the prepuce and skin of the penile shaft to the superficial inguinal nodes 4, 5

Deep Lymphatic System

  • Drains the glans and deep penile structures via separate vessels to the inguinal nodes in the femoral triangle 4, 5

Sentinel Node Location

  • Sentinel lymph nodes are most commonly located in Dassler's superomedial segment of the inguinal region 4, 5

Clinical Implications

  • The bilateral drainage pattern with potential crossover necessitates bilateral inguinal assessment in penile malignancies 5
  • Understanding this drainage is critical for sentinel node biopsy procedures and staging of penile cancer 6

References

2
Research

Evolution in the concept of erection anatomy.

Surgical and radiologic anatomy : SRA, 2011

3
Research

Penile arteries in humans. Origin--distribution--variations.

Surgical and radiologic anatomy : SRA, 1997

4
Guideline

Lymphatic Drainage Patterns

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Guideline

Penile Anatomy and Lymphatic Drainage

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

6
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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