466 APPLIED ANATOMY. 



Anteriorly it ends at the collum glandis. The corpora cavernosa and corpus spongi- 

 osum have each a separate fibrous sheath which separates the two corpora cavernosa 

 forming the septum pectiniforme: it is incomplete anteriorly, allowing the blood of 

 the two corpora cavernosa to mingle. The separate sheath of the corpus spongi- 

 osum is not as marked as those of the corpora cavernosa. The single dorsal vein of 

 the penis runs in the median line with an artery to each side and the dorsal nerves 

 still farther out. They all lie between the fascial covering of the corpora cavernosa 

 beneath and the fibrous sheath above. 



The lymphatics of the prepuce and skin drain into the inguinal nodes, those 

 of the glans empty into the nodes in and just above (inside the abdomen) the crural 

 canal; one radicle enters through the inguinal canal running posterior to the cord. 

 As the lymphatic radicles anastomose at the root of the penis a lesion on one side of 

 the organ may involve the lymphatic nodes in the opposite inguinal region. 



Practical Considerations. The opening of the prepuce is often constricted, 

 so that the glans cannot be uncovered. This condition is called phimosis. A certain 

 amount is normal in young children. At times the prepuce becomes adherent to the 

 glans but it can usually be separated by a blunt instrument without cutting. When 

 the sulcus is reached an accumulation of smegma is seen. This is produced by the 

 subaceous glands of the corona and collum glandis and under surface of the prepuce. 

 In performing circumcision the prepuce should not be drawn too far forward or too 

 much of the skin and not enough of the mucous surface will be removed; a common 



mistake. It is sufficient to remove the skin 

 and mucous membrane two-thirds of the 

 way back to the sulcus and then bring the 

 ends of the incision gradually down and for- 

 -, ; .1 ward to meet at the lower angle of the meatus 

 (Fig. 470) . By doing this the fraenum is not 

 cut and troublesome bleeding from the little 

 artery it contains is avoided. The laxity 

 of the skin, especially of the prepuce, favors 

 rapid swelling. When a contracted prepuce 

 FIG. 470. Circumcision. is forcibly drawn behind the glans it con- 



stricts the veins and the part beyond the 



constriction swells rapidly. This is called paraphimosis. To relieve it an incision is 

 made through the skin directly across the constricting band and the prepuce can 

 then be pulled forward over the glans. 



Extravasation, of urine may invade the penis beneath the fibrous sheath but does 

 not invade the glans because the sheath stops at the collum glandis. 



Fracture or rupture of the corpora cavernosa may occur from violence. The extrav- 

 asated blood is absorbed and the laceration heals with a scar. In erection this part does 

 not expand, hence deformity and distortion with interference of function may result. 

 Chordee. When the urethra is inflamed the exudate may involve the corpus 

 spongiosum surrounding it and prevent it from expanding. In erection the organ 

 assumes a downward curve, a condition designated as chordee. It disappears with 

 the subsidence of the inflammation. 



Amputation of the Penis. The penis is frequently amputated for carcinoma, 

 which disease is favored in the aged by the irritation resulting from a long-existing 

 phimosis. In operating two things are to be guarded against, bleeding and subsequent 

 contraction of the meatus. Bleeding may come from the dorsal arteries or the artery 

 which runs in the middle of each corpus cavernosum. They can first be controlled by 

 a circular rubber band and then later readily ligated. To prevent contraction of the 

 new meatus three methods are available: (i) A long dorsal and short under flap may 

 be cut and the urethra dissected out from the under flap and allowed to project beyond 

 the cut corpora cavernosa. The long dorsal flap is brought down, pierced, and the 

 urethra drawn through. It is then slit up and r-wed on each side. A few sutures 

 are then used to unite the upper and lower flaps b )w the urethra. (2) Two lateral 

 flaps may be made and the split urethra sewed in the line of union between the two 

 flaps. (3) (Writer's, University Medical Magazine, January, 1897. ) A circular cut 

 is made around the penis and the skin turned back. The penis is then turned up, 



