Narayan P, Konety B, Aslam K, Aboseif S, Blumenfeld W, Tanagho E
Department of Urology, Department of Veterans Affairs Medical Center, San Francisco, California.
J Urol. 1995 Feb;153(2):337-41. doi: 10.1097/00005392-199502000-00012.
Post-prostatectomy urinary incontinence probably is multifactorial and sphincteric nerve injury could be a contributing cause. Controversy still exists regarding the innervation of the external sphincter, and currently pudendal nerve injury is not believed to be an etiological factor in post-prostatectomy urinary incontinence. To understand better the sphincter and its innervation, we undertook an anatomical and histological study of 18 adult male cadavers, which revealed that the external urethral sphincter receives part of its innervation through special branches originating from the dorsal nerve of the penis after it splits from the pudendal nerve. These nerve branches were located 0.3 to 1.3 cm. from the prostatic apex, and in 50% of the cadavers they were identified only unilaterally or had only 1 branch on each side. The proximity of these nerves to the prostatic apex may make them liable to injury during radical prostatectomy. These nerves are most likely sensory in nature although the presence of motor components cannot be completely ruled out. Injury to these nerves may explain several features of post-prostatectomy urinary incontinence.
前列腺切除术后尿失禁可能是多因素导致的，括约肌神经损伤可能是一个促成因素。关于外括约肌的神经支配仍存在争议，目前认为阴部神经损伤不是前列腺切除术后尿失禁的病因。为了更好地了解括约肌及其神经支配，我们对18具成年男性尸体进行了解剖学和组织学研究，结果显示尿道外括约肌通过阴茎背神经从阴部神经分出后发出的特殊分支接受部分神经支配。这些神经分支位于距前列腺尖0.3至1.3厘米处，在50%的尸体中，它们仅在一侧被识别或每侧只有1个分支。这些神经与前列腺尖的接近可能使它们在根治性前列腺切除术中容易受到损伤。这些神经很可能本质上是感觉神经，尽管不能完全排除运动成分的存在。这些神经的损伤可能解释了前列腺切除术后尿失禁的几个特征。
