Strasser H, Pinggera G M, Gozzi C, Horninger W, Mitterberger M, Frauscher F, Bartsch G
Department of Urology, University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
World J Urol. 2004 Nov;22(5):335-8. doi: 10.1007/s00345-004-0416-x. Epub 2004 Sep 16.
The rhabdosphincter of the male urethra is an omega-shaped loop of striated muscle fibers that surrounds the membranous urethra at its lateral and anterior aspects. We investigated whether this muscle can be visualized by means of three-dimensional ultrasound to define morphological and dynamic ultrasound criteria. We examined the rhabdosphincter of the male urethra in 77 patients by means of this new imaging technique; 37 patients presented with urinary stress incontinence after transurethral resection of the prostate or radical prostatectomy while 40 were fully continent after radical prostatectomy and served as a control group. Contractility of the muscle was quantified by a specially defined parameter (rhabdosphincter-urethra distance). The anatomical arrangement and the contractions of the rhabdosphincter-loop could be clearly visualized in three-dimensional transrectal and transurethral ultrasound; during contraction the rhabdosphincter retracts the urethra, pulling it towards the rectum. We detected defects and postoperative scarrings in the majority of the patients with postoperative urinary stress incontinence. Furthermore, the patients presented with thinnings in parts of the muscle and atrophies of the rhabdosphincter. The rhabdosphincter-urethra distance was significantly lower in the incontinent group than in the continent group (59 vs. 1.42 mm). Our study shows that the rhabdosphincter of the male urethra can be visualized by means of three-dimensional transrectal ultrasound. The sonographic pathomorphological findings of postoperative urinary stress incontinence are well correlated well with the clinical symptoms.
男性尿道横纹括约肌是一个呈Ω形的横纹肌纤维环，在膜性尿道的外侧和前方环绕着它。我们研究了这种肌肉是否可以通过三维超声进行可视化，以确定形态学和动态超声标准。我们通过这种新的成像技术检查了77例男性患者的尿道横纹括约肌；37例患者在经尿道前列腺切除术或根治性前列腺切除术后出现尿失禁，而40例根治性前列腺切除术后完全控尿的患者作为对照组。通过一个特别定义的参数（横纹括约肌-尿道距离）对肌肉的收缩性进行量化。横纹括约肌环的解剖结构和收缩情况在三维经直肠和经尿道超声中可以清晰地看到；在收缩过程中，横纹括约肌使尿道回缩，将其拉向直肠。我们在大多数术后尿失禁患者中检测到缺陷和术后瘢痕。此外，患者还出现了部分肌肉变薄和横纹括约肌萎缩的情况。尿失禁组的横纹括约肌-尿道距离明显低于控尿组（59对1.42毫米）。我们的研究表明，男性尿道横纹括约肌可以通过三维经直肠超声进行可视化。术后尿失禁的超声病理形态学表现与临床症状密切相关。
