Department of Pediatric Surgery, CSM Medical University (previously King George Medical College), Lucknow, Uttar Pradesh, India.
Urology. 2011 Jul;78(1):159-63. doi: 10.1016/j.urology.2010.11.026. Epub 2011 Jan 22.
To report the surgical anatomy of the muscles of the urogenital diaphragm and the pattern of its vessels in the classic exstrophy bladder and incontinent epispadias.
A total of 11 patients, 9 with unoperated classic exstrophy and 2 with incontinent epispadias, who were >5 years old at presentation, were selected for the present study. Magnetic resonance imaging of the pelvis was performed using a 3.0 T magnetic resonance imaging scanner and an 8-channel coil. Computed tomography was performed for 5 patients using a multidetector row helical computed tomography scanner. Angiograms of the vessels of the urogenital diaphragm were also obtained using magnetic resonance imaging and computed tomography.
A central perineal body was seen in all the patients, with attachment of the bulbospongiosus anteriorly, superficial transverse perinei laterally, and anal sphincter posteriorly. At the root of corpora, the ischiocavernosus muscle was also seen. The triangle among the ischiocavernosus, bulbospongiosus, and superficial transverse perinei muscle was accentuated and contained the perineal artery, indirectly indicating the course of the perineal nerve. The dorsal penile artery was nearer to the posterior edge of the ischiopubic ramus, before coursing on the lateral aspect of the anterior segment of the corpora. The deep transverse perinei muscle and laid open external urethral sphincter were also seen in the proximal planes of the urogenital diaphragm.
First, all the muscles of the urogenital diaphragm, including the external urethral sphincter, were present in the exstrophy bladder. Second, the perineal artery and its sphincteric branches were in the triangular space between the ischiocavernosus, bulbospongiosus, and superficial transverse perinei muscle. Finally, the dorsal penile artery ran along the inner edge of the ischiopubic ramus before lying on lateral aspect of the corpora.
报告经典膀胱外翻和不可控性尿道上裂中尿生殖膈肌肉的外科解剖结构及其血管模式。
选择了 11 名患者，9 名患有未经手术治疗的经典膀胱外翻，2 名患有不可控性尿道上裂，这些患者在就诊时均已超过 5 岁。使用 3.0T 磁共振成像扫描仪和 8 通道线圈对骨盆进行磁共振成像，对 5 名患者使用多排螺旋 CT 扫描仪进行 CT 检查。还使用磁共振成像和 CT 获得了尿生殖膈血管的血管造影。
所有患者均可见中央会阴体，前方附着球海绵体肌，外侧附着浅层会阴肌，后方附着肛门括约肌。在阴茎根部，也可见坐骨海绵体肌。坐骨海绵体、球海绵体和浅层会阴肌之间的三角形结构明显，包含会阴动脉，间接指示会阴神经的走行。阴茎背动脉更靠近坐骨耻骨支的后缘，然后在阴茎体前段的外侧走行。在尿生殖膈的近端平面还可以看到深层会阴肌和开放的尿道外括约肌。
首先，所有尿生殖膈肌肉，包括尿道外括约肌，均存在于膀胱外翻中。其次，会阴动脉及其括约肌分支位于坐骨海绵体、球海绵体和浅层会阴肌之间的三角形区域内。最后，阴茎背动脉沿着坐骨耻骨支的内缘走行，然后位于阴茎体的外侧。
