Cadaveric Study of Nerves Supplying the Membranous Urethra
Cadaveric Study of Nerves Supplying the Membranous Urethra
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DOI：
10.1002/nau.20768
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发表时间：
2010-01-01
影响因子：
2
通讯作者：
Xu, Yue-Min
中科院分区：
文献类型：
--
作者：
Song, Lu-Jie;Lu, Hong-Kai;Xu, Yue-Min
目的：了解男性膜性尿道区域的解剖结构，以便在根治性膀胱切除术和前列腺切除术中保持尿失禁。方法：对15例男性尸体标本进行解剖，观察膜性尿道神经的分布。从盆腔内入路和会阴入路追踪神经。对尿道膜区分支的起源、走向和分布进行了详细的研究。结果：膜性尿道受胃下神经丛（IHP）分支和阴部神经（PN）盆内、盆外分支的支配。来自IHP的盆腔神经起源于盆腔内脏神经的尾端最根，沿提肛肌（LAM）表面运行，在5和7点钟位置进入膜性尿道。在40%的标本中，我们发现盆腔内分支由PN提供。在离开阴部管之前，PN发出一个盆腔内分支，穿过LAM与盆腔神经一起运动，支配膜性尿道；盆腔内支与前列腺尖的距离为5.3 +/- 1.8 mm。53.3%的标本由阴茎背神经分支支配膜性尿道；这些神经分支位于距前列腺尖4.2 +/- 1.1 mm处。结论：根治性膀胱切除术和前列腺切除术中精囊和前列腺尖部的分离可能损伤控制尿失禁的神经。Neurourol。中华医学杂志。29:592-595,2010。(C) 2010 Wiley-Liss, Inc。
Aims: To better understand the anatomy of the region of the male membranous urethra in order to preserve continence during radical cystectomy and prostatectomy. Methods: Cadaveric dissections of 15 male specimens were undertaken to investigate the nerves to membranous urethra. The nerves were traced from both an intrapelvic approach and a perineal approach. The origin, course, and distribution of the branches to the membranous urethra region were investigated in detail. Results: The membranous urethra is innervated by branches of inferior hypogastric plexus (IHP) and intrapelvic and extrapelvic branches of pudendal nerve (PN). The pelvic nerve from IHP originated from the caudal most root of the pelvic splanchnic nerve, running along the surface of the levator ani muscle (LAM) to enter the membranous urethra at the 5 and 7 O'clock positions. In 40% of specimens we found that the intrapelvic branches were supplied by the PN. Before exiting the pudendal canal, PN gives off an intrapelvic branch that traverses the LAM to course with the pelvic nerve and innervate the membranous urethra; the distance between these intrapelvic branches and prostatic apex is 5.3 +/- 1.8 mm. The branches originating from the dorsal nerve of penis innervate the membranous urethra in 53.3% of specimens; these nerve branches are located 4.2 +/- 1.1 mm from the prostatic apex. Conclusions: Dissection of the seminal vesicles and the prostatic apex during radical cystectomy and prostatectomy likely injures the nerve responsible for continence. Neurourol. Urodynam. 29:592-595, 2010. (C) 2010 Wiley-Liss, Inc.