The detailed neuroanatomy of the human striated urethral sphincter.

OBJECTIVE

To study the nerve supply of the striated urethral sphincter.

MATERIALS AND METHODS

The pelvis from six formalin-fixed male cadavers was dissected.

RESULTS

Cadaveric dissection revealed that both the intrinsic and extrinsic segments of the urethral rhabdosphincter receive their innervation from sacral roots S2-S4. The nerve fibres travel to their final destination via both the pudendal nerves and the nerve branches of the sacral roots. The terminal branches of the pudendal nerve enter the sphincteric area from the perineum. They separate shortly after they cross the ischial spine and run further ventromedially. Small branches approach the sphincter after their division from the dorsal nerve of the penis. The course of the pudendal nerve and its branching on the perineum are quite consistent. The pelvic branches travel inside the pelvis above the levator ani muscle. Among the cadavers the number of branches varied markedly, as did their site of termination (2.3 to 3.9 cm from the striated urethral sphincter). A substantial nerve approaching the sphincter from inside the pelvis was found. After it divided from the S2, S3 sacral roots it ran separately, initially just lateral to the fibres of the pelvic plexus and then on the dorsolateral surface of the rectum. In its terminal segment it dived into the levator ani muscle and terminated in the striated urethral sphincter.

CONCLUSIONS

We believe that the nerve supply to the striated urethral sphincter consists of branches from both the pudendal nerve and the 'extrapudendal' nerves that run above the levator ani muscle inside the pelvis. The variations in the course of the latter are remarkable.