Bulbocavernous Muscle Research Articles

MP43-19 A CONTEMPORARY ASSESSMENT OF NORMAL ERECTION PHYSIOLOGY

You have accessJournal of UrologySexual Function/Dysfunction: Basic Research & Pathophysiology I1 Apr 2018MP43-19 A CONTEMPORARY ASSESSMENT OF NORMAL ERECTION PHYSIOLOGY Katherine Cockerill, Ram Pathak, Ciarra Boyne, and Gregory Broderick Katherine CockerillKatherine Cockerill More articles by this author , Ram PathakRam Pathak More articles by this author , Ciarra BoyneCiarra Boyne More articles by this author , and Gregory BroderickGregory Broderick More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1418AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Classic studies using invasive caversonometry have associated a rigid erection with sustained intracavernous pressures > 80-90 mm Hg with erection pressures reaching supra-diastolic pressures during activation of bulbocavernous muscle contraction associated with pelvic stimulation. The contemporary assessment of erectile complaints relies on non-invasive color duplex Doppler ultrasound imaging (CDDU). The CDDU parameters associated with rigid erection are End Diastolic Flow Velocity = 0 (EDV0) or EDV reversed (EDVr), when intracavernous pressures equals or exceeds the diastolic blood pressure, respectively. The aim of our study is to identify age-specific diastolic blood pressure (DBP) parameters for patients who achieved normal rigidity following penile injection of Alprostadil associated with EDV0 or EDVr during CDDU. METHODS We retrospectively reviewed 97 men complaining of erectile dysfunction (ED) who demonstrated normal/sustained rigidity. Blood pressure measurements were recorded at the time of CDDU. Other parameters recorded were Peak Systolic Velocity, Resistive Index, EDV, age, BMI, co-morbidities and duration of erectile dysfunction complaints. RESULTS A total of 97 patients with a median age of 57 years and a mean BMI of 26.6 underwent CDDU. All patients achieved rigid erection following PGE1 injection; all but three patients required alpha-adrenergic injection for erection reversal at 60 minutes. Fourteen patients were classified as EDV0 (18.5%) and 83 patients were classified as EDVr (85.5%). Twenty-nine patients (29.9%) had a diagnosis of hypertension. The mean DBP at time of CDDU was 76.7 mm Hg (with SD = 10.7). The mean diastolic blood pressure between men with EDV0 and EDVr was not significantly different (79.7 vs. 75.8 mm Hg, p = 0.13). For patients age <50 years with EDV0, the median DBP was 79 with interquartile range (71, 83). For patients age > 50 years with EDV0, the median DBP was 85 with IQR (73, 89). For patients age < 50 years with EDVr, the median DBP was 76 with IQR (70, 81). For patients age > 50 years with EDVr, the median DBP was 78 with IQR (66, 84). CONCLUSIONS Our study suggests that the previously established parameters for intracavernous pressure >80-90 mm Hg for normal erection may be too high. We found mean diastolic blood pressures of 75-79 mmHg in men complaining of ED who had vascular normal erections following intracavernous Alprostadil. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e586 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Katherine Cockerill More articles by this author Ram Pathak More articles by this author Ciarra Boyne More articles by this author Gregory Broderick More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ejaculatory function after anastomotic urethroplasty for pelvic fracture urethral injuries.

The effect of anastomotic urethroplasty for pelvic fracture urethral injuries (PFUIs) on ejaculatory profile is under-reported in the literature. There is controversy as regards the effect of bulbocavernous muscle splitting during surgery on ejaculatory function (EjF). We evaluated the effects of anastomotic urethroplasty on EjF using a validated questionnaire. We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic posterior urethroplasty for PFUIs from June 1998 to January 2014. Those patients were retrieved and evaluated for their EjF using the EjF component of the Male Sexual Health Questionnaire (MSHQ). Overall, 58 patients were included in the study with a mean age of 31.6 years. All patients except one have antegrade ejaculation, and according to the overall ejaculatory score, only 5 patients (8.6%) reported ejaculatory dysfunction and the remaining 53 (91.4%) had good or average EjF. Ten men (17.2%) reported decreased volume and force of ejaculate. Decreased pleasure during ejaculation was the commonest ejaculatory disorder (39.6%). The score of each of the seven ejaculatory questions among the study patients was in harmony to the previous study of anterior urethroplasty except that men in this study had higher ejaculatory frequency and latency. Nearly all men maintained antegrade ejaculation after posterior urethroplasty for PFUIs. The risk of urethral reconstruction and splitting the bulbocavernous muscle on ejaculation seems to be minimal.

Martius flap: historical and anatomical considerations

Martius flap is used infrequently by urologists and coloproctologists for repair of fistulae in the perineal region, and is usually missing from the reconstructive palette of plastic surgeons. There is a considerable confusion regarding what the Martius flap contains. It may contain skin, fat, or muscle from the labium major region. In the original description, Heinrich Martius applied the bulbocavernous/bulbospongious muscle for repair of urethra-vaginal fistula. Nowadays, what is known as Martius flap contains the more voluminous labium major fat pad mostly independent of the above muscle. In cadaveric dissections, the labium major fat flap and the bulbocavernous muscle flap is demonstrated as two distinct entities. This way, Martius flap mentioned in the literature is a group of flaps. The history of Martius flap is reviewed, the anatomy is demonstrated on cadaveric dissections, and its clinical application is presented in a case of rectovaginal fistula repair.

Evaluation of the Role of the Puborectal Part of the Levator Ani Muscle in Anal Incontinence: A Prospective Study of 78 Female Patients With Anal Incontinence

Anal incontinence is most often linked with sphincter rupture and/or stretching the pudendal nerves. The aim of our study was to investigate the involvement of the puborectal part of the levator ani muscle in anal incontinence. Seventy-eight female patients were studied by anorectal manometry, 3-dimensional ultrasound examination, and concentric needle electromyography of the external anal sphincter, puborectal muscle, and bulbocavernous muscles, completing with the evaluation of the pudendal nerve terminal motor latencies. Damage to the puborectal muscle was defined by an abnormal ultrasound and/or abnormal electromyography. Rupture of the anal sphincter apparatus and puborectal muscle was found in 23% and 3.8%. The EMG showed damage to the puborectal part in 39 cases: this was isolated in 4 cases and combined with external anal sphincter damage in 35 patients. Unilateral or bilateral increase in the terminal motor latencies of the pudendal nerves was found in 36% (28/78) of the patients. The frequency of peripheral neurogenic lesions varied from 36% to 90% according to the electromyographic tests used. There was no correlation between puborectal part damage and resting pressure, perception threshold, and maximum tolerable rectal volume. The mean Wexner index score was not increased by the existence of a defect involving the puborectal part found by echography or by damage to the puborectal part shown by the EMG. Investigating puborectal muscle lesions reduced the percentage of idiopathic anal incontinence to 2.5%. Our study confirms the feasibility and usefulness of combined electromyography and 3-dimensional ultrasound examination of the puborectal muscle in anal incontinence.

Retracted: Physical therapy for premature ejaculation, erectile dysfunction and chronic pelvic pain syndrome

There is limited knowledge about the exact role of the pelvic floor in male sexual functioning. Pelvic floor muscle function might be involved in the enhancement of blood flow to the penis, and evidence suggests an active role for the ischio- and bulbocavernous muscles and other pelvic floor muscles in the initiation and maintenance of erection. Increased activity of pelvic floor muscles might also be preparatory to ejaculation. Studies have shown positive results after physical therapy for erectile dysfunction, premature ejaculation and chronic pelvic pain syndrome. However, the methodological quality of some of these studies is poor and further research validating specific physical therapies in the assessment and treatment of male sexual function is necessary. In this respect physical therapists have a potential role as integral members of healthcare teams involved in the improvement of male sexual health.

Pelvic floor exercises can help stop post-micturition dribble in men.

Post-micturition dribble is a lower urinary tract symptom that is mainly found in older men. Following voiding, a residue of urine becomes trapped and pools inside the bulbar urethra and, seconds later, in response to body movement, begins to drain down the urethra. The problem occurs because of weakness of the bulbocavernous muscle; this can be caused by.

Use of human fibrinogen and human thrombin for urethral reconstructive surgery

The objective of the present study is to test the use of a haemostatic sponge for urethral reconstructive surgery and to assess the relevant benefits. METHODS. The haemostatic sponge is made up of collagen with human fibrinogen and human thrombin. When the sponge gets in contact with fluids, such as blood, lymph or saline solution, the fibrinogen and thrombin are activated and form a fibrin net able to achieve local haemostasis and tissue regeneration. This kind of product was used in 30 selected patients (pts.), aged 19 - 70 (mean age: 35), who underwent single-stage anastomotic urethroplasty from January 2006 to March 2007: 22 bulbar end-to-end anastomoses and 8 bulbo- prostatic anastomoses. All operations were performed due to post-traumatic stricture of bulbar and posterior urethra. The main selection criterion for the use of the haemostatic sponge has always been the tendency to and/or the presence of bleeding in the different surgical stages. The sponge imbibed in saline solution and suitably modeled for all specific requirements was differently placed: sleeve-shaped in the case of bulbar anastomoses (16 pts.); as a "patch" in the centre of spongioplasty in bulbo-prostatic anastomoses (8 pts.), and within the widening incisions of the urethral roof performed between the two cavernous bodies at level of the intercrural septum (5 pts.). In 1 case (obese patient) a single sponge was placed after the deep perineal reconstruction on the bulbo-cavernous muscle- subcutaneous layers because of massive bleeding. RESULTS. In all cases a perfect control of haemostasis could be achieved, with immediate end of bleeding in the points where the haemostatic sponges were used. The dressings performed on day 3 upon removal of the compressive scrotum-perineal bandages did not show any late post-operative bleeding. The follow-up visits at month 1 and 3 yielded positive outcomes for all 30 patients, who achieved complete wound healing by first intention, and a perfect anastomosis especially in the bulbar end-to-end urethroplasty, confirmed by urethrografy at one month. CONCLUSIONS. The association of human fibrinogen and human thrombin in haemostatic sponges represents a manageable, useful product, apparently sure, not negatively interfering in repairing and regenerating tissue processes, and allowing a simple and direct control of important bleeding events occurring during urethral reconstructive surgery as well as other operations. It is therefore advisable to more widely use the product after a suitable followup period.

Study on the mechanism of male reproductive toxicity of metadoxine in mice and rats

To study the mechanism of male reproductive toxicity of metadoxine (MTDX) on mice and rats. Mouse multiple endpoints assay and Hershberger assay were employed to evaluate the potential estrogenic and/or antiandrogenic effects of MTDX. In mouse multiple endpoints assay, MTDX (0, 640, 1500 and 4000 mg/kg, respectively) were administered once daily p.o. for 5 days in sexually matured and ovariectomied female NIH mice. Five endpoints evaluated as markers of estrogenicity included the ratio of uterine weight to body weight, incidence and extent of uterine fluid imbibition (hydrometra), vaginal epithelial cornification during estrous cycle (estrinization) and thickness of uterine epithelial cell and stroma cell. In Hershberger assay, MTDX (0, 600 and 1500 mg/kg, respectively) was administered once daily p.o. for 10 days to castrated male SD rats with or without testosterone propionate (TP, 12.5 mg/kg, i.p. for 10 days) substitution. Relative weight of androgen dependent issues was measured. In mouse multiple endpoints assay, ratio of uterine weight to body weight was 1.33, 1.38 and 1.31 x 10(-4) in MTDX 640, 1500 and 4000 mg/kg groups, respectively, without significant difference from that in control group (1.22 x 10(-4)). Thickness of uterine uterine epithelial cell (0.90 and 1.03 microm) and stroma cell (3.38 and 3.25 microm) in MTDX 1500 and 4000 mg/kg groups was not significantly different from the control group (0.85 microm and 2.77 microm, respectively). In Hershberger assay, relative weight of prostate plus seminal vesicle, levator ani muscle and bulbocavernous muscle was 1.13, 0.17 and 0.42, respectively, in the 1500 mg/kg group, significantly decreased as compared with those in the control group (1.46, 0.24 and 0.70, respectively) (P < 0.01). Relative weight of prostate plus seminal vesicle (1.29) in the MTDX 600 mg/kg group reduced slightly, with statistical significance (P < 0.05), as compared with that in the control group (1.46). In the present study, MTDX did not exhibit any estrogenic effect in mice in vivo. However, it had antiandrogenic activity in castrated male SD rats, indicating that its antiandrogenic effect may be involved in it's male reproductive toxicity.

Bulbar urethroplasty using the dorsal approach: current techniques

The use of flaps or grafts is mandatory in patients with longer and complex strictures. In 1995-96 we described a new dorsal onlay graft urethroplasty. Over time, our original technique was better defined and changed. Now this procedure (also named Barbagli technique) has been greeted with a fair amount of enthusiasm in Europe and in the United States. The patient is placed in normal lithotomy position, and a midline perineo-scrotal incision is made. The bulbar urethra is then free from the bulbo-cavernous muscles, and is dissected from the corpora cavernosa. The urethra is completely mobilized from the corpora cavernosa, it is rotated 180 degrees, and is incised along its dorsal surface. The graft (preputial skin or buccal mucosa) or the flap is fixed and quilted to the tunica albuginea of the corporal bodies. The right mucosal margin of the opened urethra is sutured to the right side of the patch-graft. The urethra is rotated back into its original position. The left urethral margin is sutured to the left side of the patch graft and to the corporal bodies, and the grafted area is entirely covered by the urethral plate. The bulbo-cavernous muscles are approximated over the grafted area. A 16F silicone Foley catheter is left in place. Dorsal onlay graft urethroplasty is a versatile procedure that may be combined with various substitute materials like preputial skin, buccal mucosa grafts or pedicled flaps.

Midurethral bulbocavernous muscle sling for genuine stress incontinence - an alternative to synthetic slings?

Midurethral bulbocavernous muscle sling for genuine stress incontinence - an alternative to synthetic slings?

Perineal floor efficiency in sexually potent and impotent men.

Given the knowledge that the ischiocavernous and bulbocavernous muscles are involved in the erection of the penis, we studied the voluntary contractile activity of the perineal floor muscles in sexually potent and impotent men to investigate whether or not a different muscular efficiency can be found in these subjects. The activity of perineal floor muscles was studied in 76 sexually potent men and in 97 impotent men matched by age. A further group of 217 older impotent men was also studied to verify the impact of age on the efficiency of perineal floor contraction. The average myoelectrical activity of 24 maximized contractions of the perineum was measured in microV by anal plug electromyography. Perineal floor muscle contraction was significantly higher (P = 0.0007) in potent than in impotent men matched by age. In addition, in older impotent men the less perineal floor efficiency was also negatively correlated to age (r = -0.21, P = 0.002). Our results clearly demonstrated that a reduction of contractile activity of perineal muscles may be related to erectile dysfunction in younger men and an additional influence of age on perineal floor efficiency can be present in older impotent men.

Reproducibility of digital testing of the pelvic floor muscles in men

Objective: To validate the digital testing of pelvic floor muscles in men by evaluating its applicability and the reproducibility of test-retest. Design: Prospective survey on volunteer sample. Blinded between investigators. Setting: University study group with experienced physiotherapists working in a university hospital. Participants: 39 young healthy male volunteers. Intervention: Digital testing of the bulbocavernous muscles, the sphincter and externus, the puborectal muscles. Outcome Measures: Each muscle or muscle group was allocated a tripartite valuation score corresponding with muscle strength, endurance, and exhaustion. The muscle testing was repeated by the same investigator with short (10 seconds), medium (2 hours), and long (>4 hours) intervals. In 9 patients, blinded testing was performed by two independent investigators separately. The results from the different evaluations were statistically compared. Results: Digital testing proved easy to perform and was well tolerated in all patients. Test-retest showed reproducible results with short and long intervals, except for the parameter exhaustion of external anal sphincter and puborectalis muscle as determined with an interval of 2 hours. Between investigators no difference was found between scores except for strength of the bulbocavernous muscle. Conclusion: Digital testing of the pelvic floor muscles, when done by an experienced investigator and with full cooperation of the patient, is reliable and useful for clinical practice in male patients. Intracorporal muscle testing is more reliable than evaluation of superficial muscles.

Male urinary incontinence Correction with ischiocavernous muscles collaring method

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.

Electromicturition in male dogs at pelvic nerve stimulation. An urethrocystographic study.

Electromicturition released by stimulation of the pelvic nerves has been studied in 23 male mongrels. This course has been followed by measurements of the bladder pressure and urethrocystography with filmchanger and cinefluorography respectively. In order to investigate the influence of various nerves, muscles and erectile tissue on micturition, the experiment was varied as follows. The pudendal nerves were severed or stimulated. The pelvic nerves were cut proximal to the electrodes. The bulbocavernous muscle was cut. Chordotomy was performed in some dogs immediately before the examination. Sympathectomy was made 2-6 weeks prior to the study. Finally, angiography of the pudendal artery was accomplished with and without stimulation of the pelvic nerves. Electrical stimulation of the pelvic nerves always gives rise to a contraction of the detrusor. Simultaneously an antidromic stimulation of the external sphincter appears, complicating the micturition, which is clearly demonstrated during the first phase of...

産婦人科領域における会陰筋の筋電図的研究

With the purpose to investigate the functional changes of the perineal muscles brought about by pregnancy and delivery, the author determined the _??_-S relationship in the electromyograph of the bulbo-cavernous muscle and levator ani muscle in women married but not pregnant, multipara, multigravida (but without normal delivery), and in women with uterovaginal prolapse at the time when the perineal muscles had been variously made to contract intensely either at rest or intentionally all the while maintaining such a contraction in each case as constantly as possible, and studied the _??_-S relationship. The following are the results:1. In the perineal muscles like in other skeletal muscles there are two kinds of the functional differentiation in NMU, namely, kinetic NMU and tonic NMU.2. The ratio of the discharge groups between tonic NMU and kinetic NMU in the bulbocavernous muscles and levator ani muscles in any of the four goups of women mentioned above lies between 1.86 and 2.00 in the case of bulbo-cavernous muscles while between 2.14 and 2.22 in the levator ani muscles, showing no marked changes in either case.3. In the _??_-S relatinnship of the bulbo-cavernous muscles and levator ani muscles both K and T curves tend to show a shift to right in the bulbo-cavernous muscles; and therefore, the levator ani muscles seem to be the muscle more adapted for mainataining a sustained movement than the bulbo-cavernous muscles.4. That both K and T curves, especially the T curve, tend to show the shift to right in pregnancy seems to indicate that the contracting mechanism of the perineal muscles is functioning smoothly in unison with abdominal distention, the perineal muscles playing a role of barotaxic muscle.5. In the cases with uterovaginal prolapas T curve in both the bulbo-cavernous and levator ani muscles tends to show a shift to left, and in addition, S is increased in both K and T curves. This phenomenon is due to the shortened range of smoothly-working adjustment mechanism at the intentional contraction of muscles with consequent diminution in barotaxic action.As for the intensity of the muscular contraction, it is determined by the amplitude of the discharge of an individual NMU, and it is also determined by numbers of NMU acting at the same time. Therefore, there is as yet no conclusive evidence proving any clear-cut quantitative relationship between the frequency of spike discharge appearing in mucslce fibers and the intensity of the muscle contraction.However, the author has been able to clarify that the intensity of the muscle contraction, as determined even by such a simple method as to determine numbers of discharge at a given unit of time with the use of a concentric type of elctrodes, coincides with clinical findings and that the determination of the degree of perineal muscle contraction and the observation on the action of hormoues (especially progesterone) on the perineal muscle are clinically valuble. Namely:1. In pregnancy the frequency of discharge in the perineal muscles is decreesed, and it is still further decreased with advance in the pregnant month. The abortion, however, brings this lowered frequency gradually back to the normal level.2. Even in the cases of uterovaginal prolapse, the frequency of discharge is diminished, and such a diminution is proportional to the degree of uterovaginal prolapse.3. Progesterone acts as to relax the perineal muscle while estradiol has no marked effect on the myogenic tonus of the muscles.4. In the case of functional hemorrhage, the tonus of the perineal muscles is either slightly or moderately accelerated.5. The tonus of the perineal muscles in uterine hypoplasia is also accelerated.6. It seems that there is no causal realtion between hormones and the perineal muscle tonus in uterine cancer, uterine myoma, and ovarian cystom.

Studies on a vesico-anal inhibitory reflex.

Rhythmical spontaneous contraction of the external anal sphincter and bulbo-cavernous muscle in unanaesthetized spinal dogs is inhibited by quickly increasing internal pressure in the urinary bladder. From experiments of dividing and stimulating the pelvic and hypogastric nerves, the nervous pathways for this reflex were found to be as follows.(1) Afferent nervous pathways run through both the pelvic and hypogastric nerves, enter the spinal cord through the posterior root of the lumbar and sacral cord.(2) Efferent nervous pathways from the spinal cord run through the pudendal nerves.