Differences in morfology and function of urethral sphincteric mechanism in men from 3RD to 9th decade of life

Urethral sphincteric system (USS) was visualized by means of transrectal ultrasound (B&K 8808). Examinations were performed in the left decubitus position at rest and during cough test in 250 men 20 in their 3rd, 25 in 4th, 40 in 5th, 50 in 6th, 50 in 7th, 40 in 8th and 25 in 9th decade of life. Every examination was recorded as video sequences and analyzed. In every case external urethral sphincter, bulbar part of penis, urethra and interpubic disc were identified and delineated in sagittal and transverse planes. Degree of urethral and bulbar compression due to bulbospongiosus muscle contraction at maximal cough, was scaled, as well as mobility of urethra and contraction of USS.

Contraction of USS and bulbospongiosus muscle during cough causes deviation downwards and retraction of bulbar urethra from pubic bones, more prominent at intense cough. Mobility of urethra gradually decreases with age. The most prominent compression of membranous and bulbar urethra has been observed in the youngest group. In men in their fifties and older morfology and function of USS großly depended on prostatic enlargement (proximal part of external urethral sphincter atrophy in BPH).The best anatomical representation of even tiny muscular branches and fasciae were obtained in the youngest, morphology of urethral sphincteric system and adjacent structures were difficult to assess in men in their 8th and 9th decade of life because of atrophic changes in muscles, post inflamatory fibrotic tissue or fat. In the oldest sphincteric mechanism was significantly shorter and “hidden“ in the pelvic floor.