Male urinary incontinence Correction with ischiocavernous muscles collaring method

Abstract

The patient is placed in the exaggerated lithotomy position, and an inverted “U” perineal incision is made with the limbs extended to the ischial tuberosities. The ischiocavernous muscles on both sides are exposed and detached from the ischial tuberosities. To cross these muscles over to opposite sides, they should be freed for a minimum length of 5 cm. The perineal nerves and vessels which lie in the medial aspect of the ischiocavernous muscle are usually redundant and should be left undisturbed. The bulbocavernous muscle is then incised along its median raphe and dissected free from the bulbous urethra. The latter is exposed and should be freely isolated posteriorly, at least enough to admit one flngerbreadth. Through this space and the thin layer of the posterior aspect of the bulbocavernous muscles, the ischiocavernous muscle on one side is tunneled under the urethra and brought to the contralateral side (Fig. 1). It is sutured to the surface of the pubic ramus. Two separated figure-ofeight sutures using 0 nonabsorbable material or silk are sufficient. After the bulbocavernous muscle is reapproximated in the midline with 3-O chromic catgut, the ischiocavernous muscle on the other side is crossed over ventral to the bulb FIGURE 1. Diagrammatic illustration of structural relationship of procedure. (1) Right ischiocavernous muscle tunneling under (2) bulbous urethra, (3) lej? ischiocavernous muscle, and (4) bulbocavernous muscle.