Communication between spaces formed by fasciae of male external genitalia and perineum: Computed tomographic cadaveric study and clinical significance

Objective: The purposes were to evaluate the communication and the extent of the spaces formed by fasciae of the male external genitalia and the perineum and to correlate the spaces with clinical observations regarding anatomic progression of diseases. Materials and Methods: Multi-detector row computed tomography (CT) was performed through the perineum and the pelvis of 5 fresh cadavers injected with contrast material in the space between dartos and Buck fasciae of the penis. Two of the 5 cadavers, injected with the contrast material mixed with blue ink, were dissected to confirm the observations made on multi-detector row computed tomography. Computed tomographic images of 11 patients with diseases involving the potential spaces formed by the fasciae of the male genitalia and the perineum were correlated with observations made on CT of the cadavers. Results: The contrast material filling the scrotal cavity extended posteriorly in the perineum, remained far below the urogenital diaphragm, and reached superiorly to the potential space along Scarpa fascia in all cadavers. At cadaveric dissection, the ink-stained spaces were confined by the fascial planes involving Colles, Buck, dartos, and Scarpa fasciae. Spread of disease in the 11 patients (6 patients with localized genital edema, 4 with Fournier gangrene, and 1 with bulbous urethral rupture) was confined in the spaces demonstrated on CT images of the cadavers. Conclusions: Free communication and disease spread occur within the confines of the superficial perineal, scrotal, penile, and abdominal wall spaces formed by Colles, Buck, dartos, and Scarpa fasciae.