Resume
Les mécanismes locaux responsables de l’érection dépendent de l’activité musculaire lisse caverneuse et vasculaire et pour une moindre part des muscles striés ischiocaverneux. Le système nerveux autonome et somatique commande l’érection en contrôlant respectivement le tonus musculaire lisse et strié. Le nerf honteux contient des fibres somatiques efférentes et les afférences sensitives issues du pénis via le nerf dorsal du pénis L’innervation parasympathique issue de la moëlle sacrée, emprunte les nerfs pelviens puis caverneux. L’organisation du système nerveux sympathique impliqué dans l’érection est plus complexe. Les fibres nerveuses sympathiques gagnent les structures érectiles par les nerfs hypogastriques ou la chaine sympathique lombosacrée qu’elles quittent pour rejoindre les nerfs honteux ou pelvien. Le rôle de ces différents contingents nerveux est discuté à la lumière des données cliniques et de l’expérimentation animale.
Mots clefs
neuroanatomie neurophysiologie système nerveux autonome érectionPeripheral nervous control of penile erection
Abstract
Local mechanisms causing penile erection and detumescence result from variation in tone of vascular and trabecular smooth muscles and in a lesser part of striated muscles around the crura penis. All these events are neurally mediated. We reviewed human and animal data concerning the functional peripheral neuroanatorny of erection. General organization of peripheral nervous system is recalled. Somatic efferents of the pudendal nerve, originating in the sacral spinal cord, innervate the striated musculature of the perineum. Somatic afferents of the penis are conveyed by the dorsal penile nerve, a branch of the pudendal nerve. Afferent terminations project into the spinal cord, their role is discussed. Parasympathetic pathways are involved in the reflexogenic erections. Sympathetic pathways destinated to the erectile structures are more complex. They are issued from thoracolumbar spinal cord and travel through the hypogastric nerve or the lumbosacral sympathetic chain. Sympathetic fibers originating in the sacral sympathetic chain are present in both pelvic and pudendal nerves. Inhibitory role on the erection of the sympathetic nervous system is well-known, it could be also responsible for psychogenic erections. Parasympathetic and sympathetic fibees are mixed in the pelvic plexus and the cavernous nerves which are described. Relations between the four sets of peripheral nerves (somatic efferents, penile afferents, thoracolumbar sympathetic sacral parasympathetic and sympathetic) are discussed.
Key words
neuroanatomy neurophysiology autonomic nervous system penile erectionReferences
- 1.-Adaikan P.G., Lau S.C., Ny S.C., Ratnam S.S.: Physio-pharmacology of human penile erection. Autonomic neurotransmissions and receptors of the human corpus cavernosum. Asia Pacific J. Pharmacol. 1991, 6: 213–227.Google Scholar
- 2.-Aronson L.R., Cooper M.L.: Desensitization of the glans penis and sexual behavior in cats. In: Diamond M eds. Reproduction and Sexual Behavior. Bloomington: Indiana University Press, 1968, 51–82.Google Scholar
- 3.-Bemelmans B.L.H., Meuleman E.J.H., Arten B.W.M., Doesburg W.H., Van Kerrebroeck P.E.V., Debruyne F.M.J.: Penile sensory disorders in erectile dysfunction: results of a comprehensive neuro-urophysiological diagnostic evaluation in 123 patients. J. Urol. 1991, 146: 777–782.PubMedGoogle Scholar
- 4.-Benoit G., Delmas V., Gillot C., Jardin A.: The anatomy of erection. Surg. Radiol. Anat., 1987, 9: 263–272.PubMedCrossRefGoogle Scholar
- 5.-Benoit G., Giuliano F.: Anatomie de la verge et des organes érectiles. Encycl. Med. Chir. (Paris, France), à paraître.Google Scholar
- 6.-Benoit G., Quillard J., Monod P., Giuliano F., Moukarzel M., Baron J.C., Jardin A.: Identification histologique des afférences du plexus pelvien. Progres en Urol., 1991, 1: 132138.Google Scholar
- 7.-Benson G.S.: Male sexual function: Erection. Emission and Ejaculation In: E. Knobil, J. Neill, eds. The Physiology of Reproduction. New York, Raven Press 1988: 1121–1139.Google Scholar
- 8.-Bergman B., Nilsson S., Petersen I.: The effect on erection and orgasm ot cystectomy, prostatectomy and vesiculectomy for cancer of the bladder: a clinical and electromyographic study. Brit. J. Urol. 1979, 51: 114–118.PubMedCrossRefGoogle Scholar
- 9.-Bondil P., Wespes E.: Rapport du 86ème Congrès de l’Associalion Française d’Urologie. 1992, Progrès en Urologie, 1992, 2: 719–857.Google Scholar
- 10.-Booth A.M., Roppolo J.A., De Groal W.C.: Distribution of cells and fibers projecting to the penis of the cat. Soc. Neurosc. Abs, 1986, 12: 1056.Google Scholar
- 11.-Bors E., Cornar A.E.: Neurological disturbances in sexual function with special reference to 529 patients with spinal cord injury. Urol. Surv., 1960. 10: 191–222.Google Scholar
- 12.-Breza J., Aahoseif S.R., Orvis B.R., Lue T.F., Tanagho E.A.: Detailed anatomy of penile neurovascular structures surgical significance. J. Urol. 1989, 141: 437–443.PubMedGoogle Scholar
- 13.-Brindley G.S., Saverwein D., Hendry W.F.: Hypogastric plexus stimulators for obtaining semen from paraplegic men. Br. J. Urol., 1989, 64: 72–77.PubMedCrossRefGoogle Scholar
- 14.-Burnstock G.: The changing face of autonomic neurotransmission Acta. Physiol. Scand. 1986, 126: 67–91.CrossRefGoogle Scholar
- 15.-Buvat J., Lemaire A., Buvat-Herbaut M.: Safety of intracavernous injcction using an alphablocking agent J. Urol. 1989, 141: 1364–1367.PubMedGoogle Scholar
- 16.-Calaresu F.R., Mitchell R.: Cutaneous mechanreceptors in the glans penis ot the rat. Brain Res. 1969, 15: 295–297.PubMedCrossRefGoogle Scholar
- 17.-Carati C.J., Creed K.E., Keogh E.J.: Autonomic control of penile erection in the dog. J. Physiol. London 1987, 384: 525–538.PubMedGoogle Scholar
- 18.-Chapelle P.A., Durand J., Lacert P.: Penile erection following complete spinal cord injury in man. Br. J. Urol. 1980, 52: 216–219.PubMedCrossRefGoogle Scholar
- 19.-Cooper K.K.: Cutaneous mechanoreceptors of the glans penis or the cat. Physiol. Behav., 1972, 8: 793–796.PubMedCrossRefGoogle Scholar
- 20.-Cordier, Coulouma: Les nerfs érecteurs Bull. Assoc. Anat. 1933: 143–199.Google Scholar
- 21.-Courtois F., Leriche A.: L’examen sexologique du blessé médullaire. Progrès en Urol. 1991, 1: 1056–1063.Google Scholar
- 22.-Dail W.G., Trujillo D., DeLaRosa D., Waiton G.: Autonomic innervation of reproductive organs: analysis of the neurons whose axons project in the main penile nerve in the pelvic plexus of the rat. Anat. Rec. 1989, 224: 94–101.PubMedCrossRefGoogle Scholar
- 23.-Dail W.G., Walton G., Olmsted M.P.: Penile erection in the rat: stimulation of the hypogastric nerve elicits increase in penile pressure after chronic interruption or the sacral parasympathetic inflow. J. Auton. Nerv. Syst. 1989, 28: 251–258.PubMedCrossRefGoogle Scholar
- 24.-De Groat W.C., Stcers W.D.: Neuroanatomy and neurophysiology of penile erection. In Tanagho EA, Lue TF, McClure RD eds. Contemporary management of impotence and infertility. Baltimore, Williams & Wilkins, 1988: 3–27.Google Scholar
- 25.-Delmas J., Laux G.: Anatomie médico-chirurgicale du système nerveux végétatif Masson et Cie, Paris.Google Scholar
- 26.-Diederichs W., Stief C.C., Lue T.F., Tanagho E.A. Sympathetic inhibition papaverine induced erection. J. Urol. 1991, 146: 19S-198.Google Scholar
- 27.-Eckardt C.: Untersuchurlgen uber die erection des penis beim hunde. Beitr. Anat. Z. Physiol. 1863, 3: 123–150.Google Scholar
- 28.-Fay F.S., Cook P.H., Canaday P.G.: Contractile properties of isolated smooth muscle cells In: E. Bulbring and M.F. Shuba eds. Physiology of smooth muscle. Raven. Press. New York 1976: 249–264.Google Scholar
- 29.-Giuliano F.: Caractérisation anatomique et fonctionnelle de l’innervation sympathique du pénis chez le rat. DEA Sciences chirurgicales Paris. 1991.Google Scholar
- 30.-Giuliano F., Bernahé J., Benoit G., Jardin A.: Etude de l’érection chez le rat: un nouveau modèle physiologique Andrologie 1992, 2: 25–27.CrossRefGoogle Scholar
- 31.-Giuliano F., Rampin O., Benoit G., Rousseau J.P., Jardin A.: A possihle modulation of sympathetic efferents to the penis by dorsal penile nerve afferents in the rat. Int. J. Impotence Res., 1992, 4 (suppl.2): A.32.Google Scholar
- 32.-Goldstein I.: Evaluation of penile nerves. In: E.A. Tanagho, T.F. Lue, R.C. McClure eds. Contemporary management or impotence and infertility. Williams & Wilkins, Baltimore. 1988, 70.Google Scholar
- 33.-Herbert J.: The role of the dorsal nerves of the penis in the sexual behaviour of the male rhesus monkey, Physiol. Behav., 1973, 10: 293–300.PubMedCrossRefGoogle Scholar
- 34.-Huiseboch C.E., Cogeshall R.E.: An analysis of the axon populations in the nerves of the pelvic viscera in the rat. J. Comp. Neurol. 1982, 21 1: 1–10.Google Scholar
- 35.-Johnson R.D.: Efferent modulation of penile mechanoreceptor activity. Progress in Brain Res. 1988, 74: 319–324.CrossRefGoogle Scholar
- 36.-Junemann K.P., Lue T.F., Schmidt R.A., Tanagho E.A.: Clinical significance of sacral and pudendal nerve anatomy. J. Urol. 1988, 139: 74–80.Google Scholar
- 37.-Junemann K.P., Persson-Junemann C., Tanagho E.A., Alken P.: Neurophysiology of penile erection. Urol. Res. 1989, A: 213–217.Google Scholar
- 38.-Kedia K.R., Markland C., Fraley E.E.: Sexual function following high retroperitoneal lymphadenectomy. J. Urol. 1975, 114: 237–239.PubMedGoogle Scholar
- 39.-Kitchell R.L., Gilanpour H., Johnson R.D.: Penile mechanoreceptors in the rat. Exp. Neurol. 1982. 75: 229–244.PubMedCrossRefGoogle Scholar
- 40.-Kom C., Mulholland S.G., Edson M.: Etiology of fertility after retroperitoneal lymphadenectomy. J. Urol. 1971, 105: 528–530.PubMedGoogle Scholar
- 41.-Kuo D.C., Hisamitsu T., De Groal W.C.: A sym pathetic projection from sacral paravertébral ganglia to the pelvic nerve and to postganglionic nerves on the surface of the urinary bladder and large intestine of the cat. J. Comp. Neurol., 1984, 226: 76–86.PubMedCrossRefGoogle Scholar
- 42.-Langley J.N., Anderson H.: The innervation of the pelvic and adjoining viscera. J. Physiol. London 1895, 19: 71–130.PubMedGoogle Scholar
- 43.-Langley Y.N., Anderson H.: The innervation of the pelvic and adjoining viscera. Part 11: the bladder. J. Physiol. London 1985, 19: 17–84.Google Scholar
- 44.-Latarjet A., Bonnet P.: Le plexus hypogastrique chez l’hornme. Lyon Chir. 1913, 9: 221.Google Scholar
- 45.-Lavoisier P., Courtois F., Barres o. Blanchard M.: Correlations between intracavernous pressure and contraction or the ischiocavenous muscle in man. J. Urol. 1986, 136: 936.PubMedGoogle Scholar
- 46.-Lepor H., Gregerman M., Crosby R., Mostofi F.K., Walsh P.C.: Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatormical study of the adult male pelvis J. Urol. 1985, 133: 207.PubMedGoogle Scholar
- 47.-Lodder J., Zeilmaker G.H.: Effects of pelvic nerve and pudendal nerve transection on mating behavior in the male rat. Physiol. Behav. 1976, 16: 745–751.PubMedCrossRefGoogle Scholar
- 48.-Lue T.F., Tanagho E.A.: Hemodynamics of erection. In Tanagho E.A., Lue T.F, McClure RD eds. Contemporary management of impotence and infertility. Baltimre, Williams & Wilkins, 1988, 28–38.Google Scholar
- 49.-Mc Kenna K. E., Nadelhaft I.: The organization of the pudendal nerve in the male and female rat. J. Comp. Neurol. 1986, 248: 532–549.CrossRefGoogle Scholar
- 50.-Nunez R., Gross G.H., Sachs B.D.: Origin and central projections of rat dorsal penile nerve: possihle direct projections to autonomic and somatic neurons by primary afferents of non muscle origin. J. Comp. Neurol. 1986, 247: 417–429.PubMedCrossRefGoogle Scholar
- 51.-Purinton P.T., Fletcher T.F., Bradley W.E.: Gross and light microscopic features of the pelvic plexus in the rat. Anat. Rec. 1973, 175: 697–706.PubMedCrossRefGoogle Scholar
- 52.-Root W.S., Bard P.: The mediation of feline erection through sympathetic pathways with some remarks on sexual behaviour after deafferentation of the genitalia. Am. J. Physiol. 1947, 151: 80–90.Google Scholar
- 53.-Sjostrand N.O., Klinge E.: Principal mechanisms controling penile retraction and protrusion in rabbits. Acta Physiol. Scand. 1979, 106: 199–214.PubMedCrossRefGoogle Scholar
- 54.-Steers W.D., MaHory B., De Groat W.C.: Electrophysiological study of neural activity in penile nerve of the rat. Arn. J. Physiol. 1988, 254: R989-R1000.Google Scholar
- 55.-Walsh P.C., Lepor H., Eggliston J.C.: Radical prostatectomy with preservation of sexual function: anatornical and pathological considerations. Prostate 1983, 4: 473.PubMedCrossRefGoogle Scholar