A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision
View/ Open
Full Text
Date
2009-11-04Author
Long, Ronan M.
McCartan, Damian
Cullen, Ivor
Harmon, Dominic
Flood, Hugh D.
Metadata
Show full item recordUsage
This item's downloads: 0 (view details)
Cited 9 times in Scopus (view citations)
Recommended Citation
Long, Ronan M. McCartan, Damian; Cullen, Ivor; Harmon, Dominic; Flood, Hugh D. (2009). A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU International 105 (11), 1576-1578
Published Version
Abstract
OBJECTIVE
To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique.
PATIENTS AND METHODS
In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin-prick sensation.
RESULTS
Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision.
CONCLUSION
For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain-free circumcision using local anaesthesia in most men.