Neuroanatomy of the External Urethral Sphincter: Implications for Urinary Continence Preservation During Radical Prostate Surgery

Post-prostatectomy urinary incontinence probably is multifactorial and sphincteric nerve injury could be a contributing cause. Controversy still exists regarding the innervation of the external sphincter, and currently pudendal nerve injury is not believed to be an etiological factor in post-prostatectomy urinary incontinence. To understand better the sphincter and its innervation, we undertook an anatomical and histological study of 18 adult male cadavers, which revealed that the external urethral sphincter receives part of its innervation through special branches originating from the dorsal nerve of the penis after it splits from the pudendal nerve. These nerve branches were located 0.3 to 1.3 cm. from the prostatic apex, and in 50% of the cadavers they were identified only unilaterally or had only 1 branch on each side. The proximity of these nerves to the prostatic apex may make them liable to injury during radical prostatectomy. These nerves are most likely sensory in nature although the presence of motor components cannot be completely ruled out. Injury to these nerves may explain several features of post-prostatectomy urinary incontinence.