Hinata Nobuyuki, Murakami Gen
Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Department of Anatomy, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan ; Division of Internal Medicine, Iwamizawa Kojin-kai Hospital, 297-13 Shibun-cho, Iwamizawa 068-0833, Japan.
Biomed Res Int. 2014;2014:906921. doi: 10.1155/2014/906921. Epub 2014 Apr 27.
Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter.
在泌尿外科手术过程中，详细了解横纹括约肌及相邻组织的解剖结构对于确保可靠的肿瘤学和功能预后至关重要。为了描述肛提肌（LA）对尿道括约肌的功能，我们阐述了LA与尿道横纹括约肌之间的结缔组织形态。男性LA与横纹括约肌区域之间的界面组织含有丰富的不规则排列的弹性纤维和平滑肌。男性横纹括约肌与LA并列，以分散提升力，而非沿LA收缩轴串联排列。男性会阴膜薄但坚韧，沿横纹括约肌区域的下缘或底部延伸。相比之下，女性横纹括约肌，包括尿道压缩肌和尿道阴道括约肌，嵌入与厚的多层会阴膜连续的弹性纤维网中。女性LA的内下边缘附着于会阴膜的上表面，而非直接附着于横纹括约肌。我们展示了新的图表，显示了LA和横纹括约肌局部解剖结构的性别差异。
