title: Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence.
abstract: The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the "cushion" of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA).
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Rehder
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Nina M
authors.initials: NM
authors.lastname: Staudacher
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Joerg
authors.initials: J
authors.lastname: Schachtner
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Berger
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Schillfahrt
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Verena
authors.initials: V
authors.lastname: Hauser
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Mueller
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Viktor
authors.initials: V
authors.lastname: Skradski
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.affiliation: Department of Urology, Division of Reconstructive Urology, Medical University Innsbruck, 35 Anich Street, 6020 Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Glodny