Search PubMed⌕ Search

Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 73 records · Page 4Linked to original sources
PubMed1999

Role of rectosigmoid junction in fecal continence: an experimental study.

To investigate the reason why, during a mass contraction, the stool moving from the colon to the sigmoid colon stops short of the rectosigmoid junction (RSJ) instead of passing directly to the rectum, and whether the sigmoid colon and RSJ share in the anorectal continent mechanism, 12 mongrel dogs were studied. Under anesthesia, the anorectum was excised, sigmoid colon and RSJ were mobilized and the caudal end was anastomosed to the perianal skin within the external anal sphincter. The pressures in the sigmoid colon, RSJ, rectum and rectal neck were measured before anorectal excision. After excision, the pressure was registered in the neorectum (sigmoid colon) and the RSJ. The external anal sphincter EMG was recorded and the balloon expulsion test performed before and after anorectal excision and after anesthetization of the neorectum. Balloon distension of the sigmoid colon to a mean volume of 46.6+/-7. 6 ml raised the pressure in the sigmoid colon (p<0.001) and decreased it in the RSJ (p<0.05) and the balloon was dispelled to the rectum; no change occurred in the external anal sphincter EMG activity. Neorectal balloon distension to a mean volume of 62.3 +/- 8.2 ml effected a pressure rise in the neorectum (p<0.001) and a momentary increase in the external anal sphincter EMG activity, followed by a decrease of the RSJ pressure (p<0.05); the balloon was dispelled to the exterior. Balloon distension of the anesthetized neorectum effected no significant changes in neorectum and RSJ pressures or external anal sphincter EMG activity. In conclusion, it is assumed that the stools arriving from the colon are halted at the RSJ by the existing high-pressure-zone and the presence of a potential sphincter at the RSJ. We suggest that fecal continence occurs at 2 levels: an involuntary one at the RSJ and a voluntary one at the rectal neck.

Anal Canal↗
PubMed1999

Study of the electric activity of the cirrhotic liver with identification of an electrohepatogram.

In a recent study we could characterize an electrohepatogram (EHG) for the normal liver which consisted of regular monophasic, positively deflected slow waves or pacesetter potentials (PPs). We proposed that the EHG might act as an investigative tool in the diagnosis of liver diseases. In this communication, we studied the electric activity of the liver in hepatic cirrhosis. 42 patients with liver cirrhosis (30 men, 12 women, mean age 41.2+/-14.3 years) and 20 healthy volunteers (14 men, 6 women, mean age 42.2+/-13.1), who acted as controls, were enrolled in the study. Three silver-silver chloride electrodes were applied, 3-4 cm apart, to the abdominal skin parallel to and 1.5-2 cm below the right costal margin. Two 20-minute recording sessions were performed for each subject. In contrast to the regular reproducible PPs recorded in the healthy volunteers, the PPs of the cirrhotic patients had irregular rhythm, frequency and amplitude with occasional silent (no PPs) areas. The registered waves were identical from the 3 electrodes in the same subject in the healthy controls, while differed from one electrode to the other in the cirrhotic patients. The "hepatoarrhythmic" pattern encountered in the cirrhotic liver was consistent and reproducible. An EHG could be identified for the cirrhotic liver. It exhibited a "hepatoarrhythmic pattern" due probably to loss of the lobular architecture of the liver and its replacement with regeneration nodules and fibrosis.

Adult↗
PubMed1999

Transcutaneous electrohepatogram in humans.

We could recently characterize a normal "electrohepatogram" (EHG) in a canine model. It consisted of monophasic positively deflected slow waves or pacesetter potentials (PPs). A "dysrhythmic EHG" was produced when the liver was insulted by hepatic vessel clamping or liver irradiation. The postulation that electrohepatography might act as an investigative tool in liver diseases prompted the author to develop the EHG percutaneously in humans. 23 healthy volunteers (16 men, 7 women; mean age 38.6 years) and 13 patients (8 men, 5 women; mean age 34.2 years) with huge supraumbilical ventral hernia were studied. The liver was exposed during the ventral hernia repair and 3 electrodes were sutured to the liver capsule. The optimal position for percutaneous recording was identified. The 3 electrodes were placed, 5 cm apart, on a transverse line, parallel to and 1.5-2 cm below, the costal margin. PPs were recorded from the 3 electrodes applied directly to the liver and from those applied to the skin. The wave was monophasic and positively deflected with a mean frequency of 8.3 cycle/s and amplitude of 56.5 microV. The PPs had the same frequency and amplitude from the 3 electrodes applied to the same subject. The percutaneously recorded waves were identical with those recorded directly from the liver. A percutaneous EHG could be characterized for the normal liver in humans. It might show changes in liver diseases and thus act as an investigative tool in the diagnosis of such conditions.

Adolescent↗
PubMed1999

A study of the effect of distension of the rectosigmoid junction on the rectum and anal canal with evidence of a rectosigmoid-rectal reflex.

PURPOSE: To elucidate the role of the rectosigmoid junction (RSJ) in the mechanism of defecation. METHOD: Fourteen healthy volunteers were enrolled in the study (10 men, 4 women; mean age 38.2 +/- 10.6 years). The pressures in the rectum, anal canal, and RSJ as well as rectal balloon expulsion were recorded in response to balloon distension of the RSJ in increments of 10 ml of carbon dioxide (CO2) to 50 ml. The experiments were repeated after individual anesthetization of the RSJ, rectum, and anal canal. The expulsion of a 50-ml distended balloon located in the anesthetized rectum was tested. RESULTS: RSJ distension with 10 ml of CO2 produced no significant pressure changes in the RSJ, rectum, or anal canal. A 20-ml distension effected a significant pressure rise in the RSJ (P < 0.05) and the rectum (P < 0.01) and a decline in the anal canal (P < 0.05); the rectal balloon was expelled to the exterior. Similar pressure changes (P > 0.05) were recorded with a 30-, 40-, and 50-ml balloon distension. The mean latency for the RSJ response was 12.6 +/- 2.2 ms and for the rectum 15.8 +/- 2.6 ms. The balloon, distended with 50 ml of CO2 and located in the rectum, was not expelled to the exterior. Balloon expulsion occurred only with distension with volumes of above 80 ml. Individual anesthetization of the RSJ, rectum, and anal canal followed by RSJ distension produced no significant pressure changes in RSJ, rectum, and anal canal as well as no rectal balloon expulsion. CONCLUSION: The rectal contraction upon RSJ distension affirms the hypothesis of the possible involvement of a reflex, which we term "rectosigmoid-rectal reflex." This reflex relationship is evidenced by reproducibility and its absence on anesthetization of either the RSJ or the rectum, both presumably representing the two arms of the reflex arc. It is postulated that stools passing from the sigmoid colon to the rectum distend the RSJ and evoke the rectosigmoid-rectal reflex, which produces rectal contraction. The role of the reflex in defecation disorders needs to be studied.

Adolescent↗
PubMed1999

Origin of rectal electric waves: further study.

PURPOSE: The rectum possesses electric activity in the form of pacesetter and action potentials. In a recent study we suggested that the waves are not initiated by the extra-rectal autonomic innervation but might be triggered by a "rectosigmoid pacemaker." It was postulated that the electric signals are transmitted in the rectal wall through either the muscle bundles or enteric nerve plexus. This hypothesis was studied. METHODS: Under anesthesia the abdomens of 15 dogs were opened, and three electrodes were applied to the rectal serosa. Rectal electric activity and pressure were recorded. Rectal denervation was produced by bilateral pelvic ganglionectomy. The effect of adrenergic (phentolamine and propranolol) and cholinergic (atropine sulfate) blocking agents and a smooth-muscle relaxant (drotaverine) on the electromechanical activity of the denervated rectum was evaluated. RESULTS: After pelvic ganglionectomy rectal pressure decreased (P<0.05), and pacesetter and action potentials exhibited irregular rhythm and amplitude, a condition of "rectoarrhythmia." The arrhythmic pattern showed no significant change (P>0.05) on administration of the adrenergic and cholinergic blocking agents. However, it was abolished when drotaverine was given. CONCLUSION: Electric waves in the rectal wall seem to be transmitted through the muscle bundles and not the enteric nerve plexus, a finding that might assist in developing an appropriate pharmacotherapy for rectal dysmotilities and defecation disorders.

Action Potentials↗
PubMed1999

Levator ani muscle: new physioanatomical aspects and role in the micturition mechanism.

The anatomy of the levator ani muscle was studied in relation to the urinary bladder. The study was performed on 23 cadavers by dissection and microscopic examination. The levator ani is funnel-shaped and consists of a transverse portion called the levator plate and a vertical portion called the suspensory sling. The levator plate is a cone and consists of two "lateral masses" and two "crura," with the levator hiatus occupying its anterior part. Three crural patterns could be identified: classic, crural overlap, and crural scissors. The levator crura are connected to the intrahiatal organs by the hiatal ligament; the pubovesical ligament constitutes the anterior part of this ligament. The suspensory sling forms a vertical cuff around the intrahiatal organs, from which it is separated by a "tunnel septum." Its urethral portion ends in multiple fibrous septa, which penetrate the striated urethral sphincter. The levator ani plays an important role in bladder-neck fixation provided by the suspensory sling and hiatal ligament. Levator ani and hiatal ligament subluxation leads to ptosis of the urinary bladder. Furthermore, the present study demonstrates that the urethra is located in the infralevator compartment and is thus protected from the effect of intraabdominal pressure. A chronic increase in intraabdominal pressure leads to levator subluxation and sagging and to urethral exposure to intraabdominal pressure, which seems to interfere with the micturition mechanism. The infralevator location of the urethra might have a bearing on the pathogenesis and treatment of stress urinary incontinence.

Adolescent↗
PubMed1999

Rectosigmoid junction: anatomical, histological, and radiological studies with special reference to a sphincteric function.

The existence of a sphincter at the rectosigmoid junction (RSJ) is controversial. Recent studies have demonstrated a high-pressure zone within the RSJ which responds to sigmoid colon or rectal contractions by relaxation or contraction, respectively. These findings suggest the presence of a "physiological" sphincter at the RSJ. The current study investigated the anatomical and histological structure and the radiological picture of the RSJ in view of the possible existence of an anatomical sphincter at the RSJ and elucidating its function. The RSJ was studied in 28 cadavers (18 adults and 10 fully mature neonates) by dissection. A histological study of the RSJ was performed in 5 cadavers. Radiological examination using double-contrast barium enema was carried out in 50 healthy volunteers (mean age 44.2+/-14.4 years; 32 men, 18 women). The mucous membrane of the RSJ was found in folds forming a "mucosal rosette" of a mean length of 2.8+/-0.9 cm in adult specimens and 0.7+/-0.2 cm in neonates. The distal end of the mucosal rosette was sharply delineated and in some specimens protruded into the rectal lumen as a small nipple, which was surrounded by a "rectal fornix" on either side. The histological examination of the RSJ showed mucosal foldings with deep crypts surrounded by lymphocytic aggregates and marginated by muscularis mucosa. The circular muscle coat showed gradually increasing thickness towards the rectum. Nerve cells in the submucosa were located at three levels: in the vicinity of the muscularis mucosa, in the middle of the submucosa, and in the proximity of the circular muscle. Radiologically the opening of the sigmoid colon into the RSJ presented as a ring or crescent. Radiological striations representing the mucosal rosette were demonstrated. The RSJ appeared as a narrow contractile segment. The anatomical, histological, and radiological findings thus indicate that the RSJ is a segment which can be identified by its interior rather than outer aspect. The study suggests the presence of an anatomical sphincter at the RSJ which seems to regulate the passage of stools from the sigmoid colon to the rectum.

Adult↗
PubMed1999

A study of the continence mechanism of the external urethral sphincter with identification of the voluntary urinary inhibition reflex.

PURPOSE: The role of the external urethral sphincter in the opposition and interruption of the act of voiding was investigated. MATERIALS AND METHODS: The study included 7 men and 5 women with a mean age plus or minus standard deviation of 38.6 +/- 11.2 years. The bladder was filled with saline up to the urge sensation. Detrusor and posterior urethral pressures were recorded before and upon resisting the reflex detrusor contraction, and upon interrupting voiding by voluntary external urethral sphincter contraction. The test was repeated by interrupting the urinary stream with external urethral sphincter electrostimulation. The electromyography response of the internal urethral sphincter to the suppression and interruption of voiding was documented before and after internal urethral sphincter anesthetization. RESULTS: Suppression of the reflex detrusor contraction as well as of urinary stream interruption by external urethral sphincter contraction voluntarily or by electrostimulation resulted in a significant detrusor pressure decrease (p <0.01) and urethral pressure increase (p <0.001). Internal urethral sphincter electromyography activity, which normally disappears during voiding, was still present. After internalurethral sphincter anesthetization subjects suppressed the reflex detrusor contraction by voluntary external urethral sphincter contraction for a mean of 62.6 +/- 9.6 seconds, after which involuntary voiding occurred. The internal urethral sphincter showed no electromyography activity. CONCLUSIONS: The external urethral sphincter induces continence by preventing internal urethral sphincter relaxation at the detrusor contraction, which is suggested to be reflex in nature and is called the voluntary urinary inhibition reflex, and by mechanically compressing the urethra. Contraction of the external urethral sphincter, which is a striated muscle, mechanically occludes the urethra for a few seconds, by which time the detrusor has relaxed as an effect of the voluntary inhibition reflex.

Adult↗
PubMed1999

Demonstration of a "renogastric reflex" after rapid distension of renal pelvis and ureter in nonanesthetized patients.

OBJECTIVES: Renal or ureteral diseases are often associated with nausea, vomiting, and abdominal pain. The aim of the current study was to investigate the cause of gastric manifestations that accompany renoureteral disorders. METHODS: A 3F balloon-tipped catheter was introduced by means of a flexible cystoscope into the renal pelvis of 14 healthy volunteers (mean age 38.6 years; 10 men, 4 women), and the effect of rapid and slow renal pelvic and ureteral distension on the pyloric sphincter, gastric corpus, lower esophageal sphincter, and esophagus was recorded. The renal pelvis and ureter were then anesthetized and the tests repeated. RESULTS: Rapid renal pelvic distension effected a significant rise in pressure in the renal pelvis at the 6-mL distension and above and in the pyloric sphincter at 10 and 1 2 mL. Loin and epigastric pain as well as nausea in all subjects and vomiting in 5 occurred at the 10 and 1 2-mL distensions. Slow renal pelvic distension caused a renal pelvic pressure rise at the 8-mL distension and above but no pressure changes in the pyloric sphincter or gastric corpus; loin pain, but not nausea or vomiting, occurred. Rapid ureteral distension at 1 mL was associated with loin and epigastric pain in all subjects and vomiting in 3. No epigastric pain, nausea, or vomiting occurred with slow ureteral distension. Renal pelvic or ureteral distension, slow or rapid, caused no pressure changes in the lower esophageal sphincter or esophagus. Distension of the anesthetized renal pelvis or ureter effected no gastric or esophageal pressure changes and no nausea or vomiting. CONCLUSIONS: The study demonstrated the possible existence of a reflex relationship between the distension of the renal pelvis and ureter and the pressure of the pyloric sphincter. This reflex effect was reproducible and did not occur when the anesthetized renal pelvis or ureter was distended. We call this reflex relationship the "renogastric reflex" and suggest that it explains the cause of gastric manifestations that might occur with renoureteral disorders.

Adult↗
PubMed1999

Magnetic stimulation: a novel method for inducing evacuation of the neuropathic rectum and urinary bladder in a canine model.

OBJECTIVES: To study the effect of sacral magnetic stimulation (MS) on the neuropathic rectum and urinary bladder in dogs. It has been demonstrated in a canine model and in humans that sacral MS of both the empty and full rectum effected a significant increase in rectal and vesical pressures. Evacuation of the full rectum, as well as balloon expulsion, were achieved. METHODS: In 15 dogs, bilateral pelvic ganglionectomy was carried out, and rectal and vesical denervation was confirmed by bethanechol and atropine testing. Sacral MS of the empty and full rectum and urinary bladder were performed by means of a magnetic stimulator and coil. The electromyographic (EMG) response of the rectus abdominus muscles to sacral MS was recorded. RESULTS: After pelvic ganglionectomy, the rectal, vesical, anal, and urethral pressures revealed a significant decrease (all P <0.05). On sacral MS of the empty rectum and urinary bladder, rectal and vesical pressures increased (both P <0.001) and anal and urethral pressures did not change (both P >0.05). Atropine injection abolished the rectal and vesical response to sacral MS; bethanechol did not. During sacral MS, no EMG activity of the rectus abdominus muscles was recorded. Intermittent sacral MS of the full rectum and urinary bladder raised rectal and vesical pressures (both P <0.001) and effected evacuation. CONCLUSIONS: Sacral MS causes evacuation of the neuropathic rectum and urinary bladder in a canine model. The technique is simple, noninvasive, nonradiologic, and cost-effective and has no adverse effects. It is suggested that it be used for evacuation of the neuropathic rectum and urinary bladder in patients with spinal cord injury.

Animals↗
PubMed1999

The effect of vesical filling and voiding on the anorectal function with evidence of a 'vesico-anorectal reflex'.

The aim was to evaluate the effect of vesical filling and voiding on anal continence and rectal pressure. Fourteen healthy volunteers (age 37.2 +/- 9.6 years; 10 men, four women) were studied. The response of the rectal pressure and EMG of the external (EAS) and internal (IAS) anal sphincters to slow vesical filling and voiding was recorded before and after individual anaesthetization by xylocaine of the EAS, rectum and urinary bladder. Saline instead of xylocaine was used as control testing. The rectal pressure and EAS EMG activity showed no response to vesical filling (P > 0.05, P > 0.05, respectively) while a momentary increase in both parameters occurred upon voiding (P < 0.05, P < 0.01, respectively). The IAS EMG exhibited no response to either filling or voiding. Separate anaesthetization of either of the EAS, rectum or bladder produced no response of the rectal pressure or EAS EMG activity upon vesical voiding, whereas a response was registered after saline administration. The increase of the rectal pressure and EAS EMG activity upon voiding suggests the presence of a reflex relationship between the two actions. This relationship is evidenced by reproducibility and by abolition of the response on anaesthetizing either of the proposed two arms of the reflex: the anorectum and the bladder. We call this reflex 'vesico-anorectal reflex'. The clinical significance of this vesico-anorectal reflex remains to be established.

Adult↗
PubMed1999

Anal submucosal injection: a novel modality for the treatment of advanced rectal cancer.

AIMS: To investigate the efficacy of methotrexate (MTX) submucosal anal injection in the treatment of advanced rectal cancer. METHODS: Thirty-six patients (age 36-66 years; 21 men, 15 women; 20 patients with stage T3N1M0 and 16 with T4N1M1 rectal cancer) were injected with MTX in the anal submucosa. A comparative group of eight patients (age 38-62 years: five men, three women; four with T3N1M0 and four with T4N1M1 rectal cancer) was injected with MTX intravenously. The dose in both groups was 100 mg every 5 days for five consecutive doses and the course was repeated at 3-week intervals. MTX serum and tumour concentrations were estimated 30 and 60 min after MTX injection. The patients received MTX as outpatients. RESULTS: In the anal group, six of 20 patients with T3 tumour showed complete tumour regression and were alive 28-46 months after the start of the treatment. Partial response occurred in 25 patients: 14 of stage T3 and 11 of T4. The 14 T3 patients underwent combined excision operation and 9/14 were alive 26-68 months from the time of operation. Five of the 16 T4 patients showed tumour and metastatic progression. Mild toxicity occurred in six of 36 patients while the haematological reserve was unchanged in all the patients. All eight patients in the parenteral group showed progress of the malignant lesions under treatment and toxic manifestations were so severe that the treatment had to be interrupted. The MTX concentration in serum was significantly higher after parenteral than after anal injection, while in tumour tissue it was higher after anal administration. CONCLUSIONS: The results show that MTX submucosal anal injection is effective in treatment of T3 rectal cancer due to high MTX concentration in the tumour. Toxicity was mild owing to low level of serum MTX. The anal route of administration is safe, well tolerated and can be used on an outpatient basis.

Adult↗
PubMed1999

Study of the electric activity of the liver with identification of a normal 'electrohepatogram' in a canine model.

OBJECTIVE: The electric activity of the liver was studied in 14 mongrel dogs, aiming at characterizing a normal electrohepatogram (EHG) that might act as a standard for abnormal recordings in hepatic pathological conditions. METHODS: Three monopolar silver-silver chloride electrodes were sutured to the anterior liver surface under anaesthesia. A recording session of 60 min was performed daily for 10 days. The effect of temporary clamping of the hepatic artery and portal vein, and of liver insult by irradiation, on the hepatic electric activity was also studied. RESULTS: Electric waves were recorded from the three electrodes. They were monophasic with a positive deflection, had identical frequency and amplitude from the three electrodes, and were reproducible when the test was repeated in the same animal. The mean frequency was 10.6 +/- 1.8 cycles/s and amplitude 63.7 +/- 11.4 microV. Fast activity spikes and abnormal waves were not encountered. Temporary occlusion of the hepatic artery and portal vein produced irregularities in the wave frequency and amplitude; the wave dysrhythmia disappeared after clamp release. The EHG following liver insult by irradiation exhibited two patterns: silent and dysrhythmic. CONCLUSION: A normal EHG could be characterized in the canine model. A dysrhythmic pattern was produced when liver vessels were clamped and following liver injury. It is suggested that in liver diseases, the normal EHG pattern is deranged and might thus act as a diagnostic tool in such conditions.

Animals↗
PubMed1999

Ureteropelvic junction: A study of its anatomical structure and function. Ureteropelvic junction sphincter?

PURPOSE: To study the anatomy of the normal ureteropelvic junction (UPJ) and investigate its pressure response to distension, aiming at elucidation of its function in the light of its anatomical structure. METHOD: The UPJ of 25 cadaveric specimens (15 male, 10 female; 15 adults, mean age 33.6 +/- 8.4 years; 10 fully mature neonatal deaths) was studied morphologically and microscopically after staining with hematoxylin and eosin and Masson's trichrome. Furthermore, the length of the UPJ as well as the UPJ pressure response to UPJ distension were assessed in 13 subjects (8 men, 5 women, age 48.8 +/- 10.3 years). The response of the anesthetized UPJ to distension was reported in 7/13 subjects and of the saline-injected UPJ in the remaining 6/13. The UPJ had been anesthetized by injecting 1% xylocaine into its wall. RESULTS: Grossly, there were no features characteristic of the UPJ externally, although internally the mucosa was thrown into folds forming a 'mucosal rosette'. Microscopic examination showed the muscle fibers to be arranged in two well-formed layers: circular and longitudinal. Mucosal folding and structured muscle fiber arrangement were lacking in the adjacent renal pelvic and ureteral walls. The mean UPJ length in adults as measured manometrically by the pull-through technique was 6.9 +/- 1.5 mm. UPJ distension led to an elevated UPJ pressure; the latter increased with increase of the volume of distension. There was no UPJ pressure response to distension of the UPJ locally anesthetized by injecting xylocaine into its tissue, but there was response when saline was injected into the tissue of the UPJ. CONCLUSION: The UPJ might be identifiable by the presence of the mucosal rosette. The reaction of the UPJ to distension probably indicates that the UPJ possesses a motile activity. This, as well as the presence of a structured muscle coat at the UPJ would suggest the presence of a 'sphincter' at the UPJ.

Adult↗
PubMed1999

Surgical anatomy of the somatic terminal innervation to the anal and urethral sphincters: role in anal and urethral surgery.

PURPOSE: The gross anatomy of the pudendal nerve branches was studied to identify more precisely the neuroanatomical relationship in the region of the anal canal, bladder neck and proximal urethra. Such knowledge is essential for the development of surgical techniques that avoid nerve injury in sphincteroplasty for anal and urinary stress incontinence, and in pudendal canal decompression. MATERIALS AND METHODS: The pudendal nerve terminal branches were dissected in 7 female and 5 male formalin fixed cadavers, including 6 fully mature neonates and 6 adults, a mean age of 37.6 years. The nerves were traced from the pudendal nerve to their termination in the anal and urethral sphincters, and pelvic floor muscles. RESULTS: The inferior rectal nerve occupied the lower half of the ischiorectal fossa. Immediately after emerging from the pudendal canal it extended a motor branch to the levator ani muscle and the cutaneous perianal and scrotal branches. The nerve terminated in the external anal sphincter at the 3 and 9 o'clock positions. Inside the pudendal canal the perineal nerve gave rise to a scrotal branch which joined the scrotal branch of the inferior rectal nerve to form the common scrotal nerve. About 2 to 3 cm. from the pudendal canal the perineal nerve extended a branch to the bulbocavernosus muscle and divided into the terminal scrotal and motor branches, which penetrated the striated urethral sphincter at the 3 and 9 o'clock positions. The deep dorsal nerve of penis or clitoris coursed forward into the ischiorectal fossa, emerged from the deep perineal pouch and penetrated the suspensory ligament to the dorsum of the penis or clitoris. CONCLUSIONS: The identification of the precise anatomical relation of the somatic nerve termination to the anal and urethral sphincters seems vital to avoid sphincter denervation during surgery for the correction of fecal and stress urinary incontinence.

Adult↗