Strasser H, Frauscher F, Helweg G, Colleselli K, Reissigl A, Bartsch G
Department of Urology, University of Innsbruck, Austria.
J Urol. 1998 Jan;159(1):100-4; discussion 104-5. doi: 10.1016/s0022-5347(01)64025-4.
A combined anatomic-sonographic study was undertaken to investigate whether the anatomical arrangement and the contractions of the rhabdosphincter of the male urethra could be visualized by transurethral ultrasound. Furthermore, this new technique was compared with standard urodynamic tests.
In 7 cadavers transurethral ultrasound was performed to define sono-morphological criteria of the rhabdosphincter, and the sonographic pictures were then compared to histological sections. In 48 patients the rhabdosphincter of the male urethra was investigated by transurethral ultrasound and urodynamic techniques. Of these patients 40 were completely continent after radical prostatectomy and 8 presented with urinary stress incontinence after transurethral resection of the prostate or radical prostatectomy. The decrease of the distance between the rhabdosphincter and the transducer during contraction served as quantitative parameter for the contractility of the muscle.
The anatomical arrangement and contractions of the rhabdosphincter loop could be clearly visualized on transurethral ultrasound (during contraction the rhabdosphincter retracts the urethra, pulling it towards the rectum). Ultrasound showed scars in 3 patients with postoperative urinary stress incontinence, thinning of the muscle in 3 complete atrophy of the rhabdosphincter in 2 and minimal contractions of the rhabdosphincter in 1. Urethral closure pressures were decreased and decrease in rhabdosphincter-transducer distance was statistically significantly decreased in the incontinent patients.
Our sono-morphological data and anatomical histological results strongly suggest that the rhabdosphincter constitutes the main component of the continence mechanism in post-prostatectomy patients. Unlike urethral pressure profiles, which can only reveal zones of higher intraluminal pressure between the bladder and the penile urethra, transurethral ultrasound is highly specific for measurement of the function of the rhabdosphincter.
进行一项解剖学与超声联合研究，以探究经尿道超声能否显示男性尿道横纹括约肌的解剖结构及其收缩情况。此外，将这项新技术与标准尿动力学检查进行比较。
对7具尸体进行经尿道超声检查，以确定横纹括约肌的超声形态学标准，然后将超声图像与组织学切片进行比较。对48例患者采用经尿道超声和尿动力学技术研究男性尿道横纹括约肌。其中40例患者在根治性前列腺切除术后完全控尿，8例患者在经尿道前列腺切除术或根治性前列腺切除术后出现尿失禁。横纹括约肌与换能器之间距离在收缩时的减小作为肌肉收缩力的定量参数。
经尿道超声可清晰显示横纹括约肌环的解剖结构及其收缩情况（收缩时横纹括约肌使尿道回缩，将其拉向直肠）。超声显示3例术后尿失禁患者有瘢痕形成，3例肌肉变薄，2例横纹括约肌完全萎缩，1例横纹括约肌收缩微弱。尿失禁患者的尿道闭合压降低，横纹括约肌与换能器之间的距离减小，差异有统计学意义。
我们的超声形态学数据和解剖组织学结果有力地表明，横纹括约肌是前列腺切除术后患者控尿机制的主要组成部分。与只能显示膀胱与阴茎尿道之间管腔内压力较高区域的尿道压力曲线不同，经尿道超声对测量横纹括约肌的功能具有高度特异性。
