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SURGICAL  ANATOMY   OF   MALE  URETHRA

 

 

Contrary to common thought , anatomy is no "dead science". It brings no perfect nor complete knowledge and keeps growing by new techniques and more observations, even from simple surgeon's remarks..

In the field of perineal ligaments a dozen of competing theories, four centuries after Vesalius, still attempt to depict structures that sketch the frame of daily urological practice.

My purpose is to show that the male urethral canal is suspended to a continuous fibrous layer, from the glans penis to the prostate, and that this very particular coat may be used for repairing the damaged urethra.

 

 

SOME   NOTEWORTHY   structures

 

PERSONAL  OBSERVATIONS     

 

MEMBRANOUS   URETHRA

Formolized urethro-prostatic block. ( Service d' Anatomie, Univ.Officielle du Congo, Campus de Lubumbashi, Prof. J. Compère.)

Contrary to various classical theories, the membranous urethra exists by itself.   It is a distinct entity and can be treated electively.

 

CAVERNOUS   AND   SPONGIOUS  BODIES

 

 

 

Mobile urethra comprises three layers :

1) the mucosa is thick, expandable with numerous recesses ( Morgagni's foramina and foraminula ) which provide additionnal expansion surface for erection.

2) the spongious body, where spiral bundles of elastic fibers enclose blood spaces and constitute the very special erectile tisssue.

3) the tunica albuginea.

 

The corpora cavernosa which constitute the penis shaft have a structure very similar to the spongious body, differing only by a more dense collagenic tissue and a much more consistent albuginea. Similarities of cavernous and spongious organs point out  a clear suggestion for plastic reconstruction purpose..

 

 

 

the  fibrous  roof  of  penile urethra

 

At  the level  of  the   navicular  fossa   the urethra  is  suspended  to  a  fibrous  layer  in continuity  with  the  sub-cavernous  groove.

 

 

the  sub-CAVERNOUS GROOVE   AND   THE URETHRAL   LIGAMENTS

 

Crura of cavernous bodies  are attached to the sides of the pubic arch. and connected to each other by the triangular ligament  (ligament de l' entrecuisse) ;  this one continues upwards into the  preprostatic ligament.

Inside the triangular ligament palpation discloses a transverse band : the Henle's ligament. From that ligament fibers insert downwards to the upper side of bulbar urethra and form a suspensory ligament . When detaching urethra the surgeon has to cut that ligament to access to the Cowper's glands and to the prostate apex inside the sphincter ring.

 

BLOOD  VESSELS  OF  MALE  URETHRA

 

 

 

 

The branches of internal pudendal arteries give blood supply to the urethra from outside inwards. They are paired and symmetrical.

Access to membranous urethra that follows the roof in the sagittal plan entails no vascular risk.   On the contrary dissecting round behind the bulb compels the surgeon to sever the bulbo-cavernous muscles which are essential to eject the last  drops  of mictional  urine  and endangers important posterior vessels which  provide  filling  and  erection. of  the corpora cavernosa.

 

 

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