Penile Cutaneous Nerve Distribution Pattern: An Anatomical Study to Guide Penile Surgery

BACKGROUND: The overall distribution pattern of penile cutaneous nerves (PCNs) is critical for sexual function and penile surgeries but remains incompletely characterized. OBJECTIVE: To systematically elucidate the overall innervation pattern of PCNs and provide an anatomical basis for surgical practices. METHODS: PCNs origins were examined in 24 formalin-fixed adult male cadavers (12 incompletely covered prepuces, 12 completely covered prepuces) through dissection. Modified Sihler's staining with clock‑point positioning enabled visualization of PCNs distribution. Nerve density was quantitatively assessed. RESULTS: PCNs originated from the dorsal nerve of the penis (DNP) and the posterior scrotal nerve. The former mainly innervated the dorsal semicircle of the penile skin extending from the 7 to the 5 o'clock positions via the 12 o'clock position; the penile branches of the latter mainly innervated the ventral aspect of the 5-7 o'clock region and the frenulum. However, numerous anastomoses between the two nerves were observed in the 3-5 and 7-9 o'clock regions. Nerve density increased from the proximal shaft to the prepuce and was higher ventrally than dorsally. CONCLUSIONS: This study demonstrates the dual innervation pattern and regional density of PCNs, providing important morphological evidence for guiding DNP stump localization, optimizing circumcision anesthesia, and guiding flap design and sensory reconstruction.