Dalpiaz Orietta, Mitterberger Michael, Kerschbaumer Andrea, Pinggera Germar M, Bartsch Georg, Strasser Hannes
Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
BJU Int. 2008 Nov;102(10):1448-51. doi: 10.1111/j.1464-410X.2008.07772.x. Epub 2008 Jun 6.
To investigate, in a morphological study, the anatomy of the male rhabdosphincter and the relation between the membranous urethra, the rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue.
In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections.
In the histological cross-sections, the rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery.
Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the rhabdosphincter and the NVBs. This approach provides the basis for sparing of the rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.
在一项形态学研究中，探究男性横纹括约肌的解剖结构以及膜性尿道、横纹括约肌与神经血管束（NVBs）之间的关系，为后尿道手术入路提供解剖学依据，因为尿道重建手术的成功结果仍然是一个具有挑战性的问题。
共研究了11个完整骨盆以及4个包含前列腺、直肠、膜性尿道和横纹括约肌的组织块。除了解剖学标本制备外，还通过连续组织学切片研究了后尿道及其相互关系。
在组织学横切面上，横纹括约肌围绕膜性尿道的前侧和外侧形成一个Ω形环。在腹侧和外侧，它通过一层薄的结缔组织鞘与膜性尿道分隔开。通过将神经和血管向外侧移位的中线入路，可以避免对NVBs的损伤。仔细解剖膜性尿道腹侧壁与横纹括约肌之间的薄腹侧结缔组织鞘，可以将这两个结构分离而不损伤任何一个。这种解剖学方法可用于尿道手术中前尿道壁的解剖。
基于精确的解剖学知识，可以在后尿道腹侧壁进行解剖和暴露，而不会损伤横纹括约肌和NVBs。这种方法为保留横纹括约肌以及治疗球膜部尿道狭窄的尿道手术取得成功结果提供了基础。
