Given that the De Novo penile fibro-vascular assembly has been restudied and thoroughly exploded in the latest decades, the anatomical exact location for the veno-occlusive (VOD) mechanism has not been revealed. We sought to conduct a revisiting study to fill the research gap. This unclear issue prompts us to do further study.

From May 2023 to October 2024, six videos of electrocautery on defrosted human cadaveric penises, along with data from 8 patients undergoing corporotomy for penile girth enhancement and 15 photos from cadaveric dissections, were analyzed. Loupe-aided observation was employed to differentiate the outer longitudinal, inner circumferential tunica layers, and the membrane encircling the corpora cavernosa. Pathological images were assessed for electrocautery effects at varying intracorporeal pressures (0 to 150 mmHg). Hydro-dissection and precise opening of the tunica albuginea at the 3 and 9 o’clock positions were performed during corporotomy. Two of the eight patients were recorded for video documentation.

From six videos of electrocautery on defrosted human cadaveric penises, it was observed that sinusoidal electrocautery effects could be minimized intracorporeally, with the venous outflow mechanism (VOM) positioned between the inner and outer tunica albuginea. In eight patients undergoing corporotomy for penile enhancement, an amniotic-like membrane, referred to as the cavernosal membrane (CM), was identified encasing the sinusoidal blood between the sinusoids and the inner tunica albuginea. The CM functions as a waterproof barrier for cavernosal blood. If damaged intraoperatively, significant blood leakage from the sinusoids occurred. Furthermore, based on 15 photos of cadaveric dissection, CM was clearly visible and was traversed by an emissary vein that passed obliquely through the bilayered tunica.

In conclusion, this study highlights the significant role of the cavernosal membrane (CM) in preserving the integrity of sinusoidal blood within the corpora cavernosa during penile procedures. The CM, acting as a protective barrier between the inner tunica albuginea and the sinusoids, is crucial in maintaining the stability of intracorporeal blood flow. Damage to this membrane during surgery can lead to substantial blood loss, underlining the importance of careful surgical techniques to preserve its function. The observations from the cadaveric dissections and electrocautery videos provide valuable insights into the anatomy and functional importance of the CM, offering potential guidance for improving outcomes in penile enhancement surgeries. Further studies are needed to explore the full clinical implications of these findings.