J.-U. Stolzenburg

Functional anatomy of the male continence mechanism

ZusammenfassungDie anatomischen und funktionellen Grundlagen der Harnkontinenz sind beim Mann weniger gut erforscht als bei der Frau. Insbesondere das Zusammenwirken der einzelnen Komponenten und die dynamische Verankerung im Beckenboden bedürfen einer neuen anatomisch-funktionellen Interpretation, um an der Physiologie des Blasenhalses orientierende Therapieansätze generieren zu können.Der Fokus anatomischer Untersuchungen sollte daher neben dem Externus als Hauptmuskel für den Harnröhrenverschluss auch auf den glattmuskulären (Internus, der innere Anteil des Externus, die urethrale Längsmuskulatur, Elemente des Centrum tendineums und des ventralen Suspensionsapparates), bindegewebigen und nervalen Strukturen liegen. Der die Position des Blasenhalses fixierende ventrale Suspensionsapparat scheint dabei für die Kontinenz und Miktionseinleitung von besonderer Bedeutung zu sein. Diese neuen Erkenntnisse implizieren wie bei der Frau ein integrales Konzept. Ein erster Schritt hierzu wäre eine einheitliche und aktualisierte anatomische Nomenklatur.AbstractThe basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.The basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.

Funktionelle Anatomie des männlichen Kontinenzmechanismus

ZusammenfassungDie anatomischen und funktionellen Grundlagen der Harnkontinenz sind beim Mann weniger gut erforscht als bei der Frau. Insbesondere das Zusammenwirken der einzelnen Komponenten und die dynamische Verankerung im Beckenboden bedürfen einer neuen anatomisch-funktionellen Interpretation, um an der Physiologie des Blasenhalses orientierende Therapieansätze generieren zu können.Der Fokus anatomischer Untersuchungen sollte daher neben dem Externus als Hauptmuskel für den Harnröhrenverschluss auch auf den glattmuskulären (Internus, der innere Anteil des Externus, die urethrale Längsmuskulatur, Elemente des Centrum tendineums und des ventralen Suspensionsapparates), bindegewebigen und nervalen Strukturen liegen. Der die Position des Blasenhalses fixierende ventrale Suspensionsapparat scheint dabei für die Kontinenz und Miktionseinleitung von besonderer Bedeutung zu sein. Diese neuen Erkenntnisse implizieren wie bei der Frau ein integrales Konzept. Ein erster Schritt hierzu wäre eine einheitliche und aktualisierte anatomische Nomenklatur.AbstractThe basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.The basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.

Funktionelle Anatomie des männlichen Kontinenzmechanismus@@@Functional anatomy of the male continence mechanism

ZusammenfassungDie anatomischen und funktionellen Grundlagen der Harnkontinenz sind beim Mann weniger gut erforscht als bei der Frau. Insbesondere das Zusammenwirken der einzelnen Komponenten und die dynamische Verankerung im Beckenboden bedürfen einer neuen anatomisch-funktionellen Interpretation, um an der Physiologie des Blasenhalses orientierende Therapieansätze generieren zu können.Der Fokus anatomischer Untersuchungen sollte daher neben dem Externus als Hauptmuskel für den Harnröhrenverschluss auch auf den glattmuskulären (Internus, der innere Anteil des Externus, die urethrale Längsmuskulatur, Elemente des Centrum tendineums und des ventralen Suspensionsapparates), bindegewebigen und nervalen Strukturen liegen. Der die Position des Blasenhalses fixierende ventrale Suspensionsapparat scheint dabei für die Kontinenz und Miktionseinleitung von besonderer Bedeutung zu sein. Diese neuen Erkenntnisse implizieren wie bei der Frau ein integrales Konzept. Ein erster Schritt hierzu wäre eine einheitliche und aktualisierte anatomische Nomenklatur.AbstractThe basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.The basic structures and organs contributing to continence in men are far less well investigated than in women. This concerns anatomical and functional aspects as well. Especially the cooperation of single components and the dynamic anchoring in the pelvic floor require further investigation. An improved anatomical-functional interpretation is needed to generate therapeutic concepts orientated at the physiology of the bladder neck.Therefore, the focus of anatomical investigations should be on the external sphincter which is the main muscle responsible for urethral closure as well as on the connective tissue, smooth muscular and neuronal structures in the pelvis. The smooth muscular structures involved are the internal sphincter, the inner parts of the external sphincter, the urethral longitudinal musculature, and parts of the centrum perinei and of the ventral suspension apparatus which fixes the position of the bladder neck and seems to be vital for continence and initiation of micturition. These new findings imply an integral concept for men as was developed for women. A first step in this regard would be a consistent and updated anatomical nomenclature.