Anatomy and Strength of the Tunica Albuginea: Its Relevance to Penile Prosthesis Extrusion

In 7 male cadavers the anatomical structure, thickness and tensile strength of the tunica albuginea of the penis, measured at specific locations, were determined. The tunica is composed of inner circular and outer longitudinal layers made up of collagen bundles. The outer layer appears to determine, to a large extent, the variation in thickness and strength of the tunica. The ventral groove (found between the 5 and 7 o'clock positions), which houses the corpus spongiosum, lacks outer bundles and appears vulnerable to perforation. The thickness of the tunica measured at the 7, 9 and 11 o'clock positions was 0.8 +/- 0.1 mm, 1.2 +/- 0.2 mm and 2.2 +/- 0.4 mm, respectively. Differences in the thickness of the tunica at specific locations were statistically significant (all p < or = 0.018). Symmetrical measurements were nearly identical in a mirror image arrangement (3, 5 and 1 at the 9, 7 and 11 o'clock positions, respectively). The stress on the tunica at penetration (breaking point pressure) measured at the 7, 9 and 11 o'clock positions was 1.6 +/- 0.2 x 10(7) N/m.2, 3.0 +/- 0.3 x 10(7) N/m2 and 4.5 +/- 0.5 x 10(7) N/m.2, respectively. The strength and thickness of the tunica correlated in a statistically significant manner with location (r = 0.911 and p = 0.0001). The most vulnerable area is on the ventral aspect (which lacks the longitudinally directed outer layer bundles), where most prostheses tend to extrude. This finding supports our belief that prosthesis extrusion often has an anatomical basis and is not merely a phenomenon caused by infection or compression.