Anatomy and innervation of the rhabdosphincter of the male urethra

Abstract

The striated sphincter of the male urethra and its innervation are still a subject of controversy. Essentially, two concepts of its anatomy can be found in the literature. Some authors describe the rhabdosphincter as part of the urogenital diaphragm caudal to the prostate, others as a striated muscle which extends from the base of the bladder to the "urogenital diaphragm." In a combined anatomic-histologic study the striated sphincter and the pudendal nerve were examined by means of anatomical dissections and serial anatomical as well as histological sections of 12 male pelves. Furthermore, radical prostatectomy was performed in a cadaver specimen; subsequently, the so-called "urogenital diaphragm" was excised and then examined histologically. The varying number of striated muscle fibers caudal to the prostate is of particular interest. In fetuses, there are abundant striated muscle fibers dorsal to the membranous urethra, where they are arranged as a circular collar around the urethra. In the adult male, hardly any striated muscle fibers can be found dorsal to the urethra; in a majority of cases this region is devoid of striated muscle fibers. Inserting dorsally in the perineal body, the fibers form an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. The existence of a "urogenital diaphragm" and a strong, circular, striated "external sphincter urethrae" completely encircling the urethra caudal to the apex of the prostate could not be confirmed by our anatomical and histological investigations. Our study shows that the striated muscle fibers run in a cranial direction from the bulb of the penis to the base of the bladder along the anterior and lateral aspects of the prostate and the membranous urethra. Further dissection studies revealed that the rhabdosphincter is supplied by branches of the pudendal nerve after leaving the pudendal canal.