Sonographic imaging of the puborectalis

Area of Science:

• Anatomy
• Medical Imaging
• Urology

Background:

• Understanding the male puborectalis anatomy is crucial for pelvic floor health.
• Current imaging methods may not fully elucidate the puborectalis's relationship with adjacent structures.
• Preventing iatrogenic injury during prostate interventions requires precise anatomical knowledge.

Purpose of the Study:

• To compare the appearance of the normal male puborectalis using transrectal ultrasound (TRUS) with anatomical examinations.
• To enhance the understanding of the prostate's relationship to the adjacent pelvic floor.
• To inform strategies for preventing puborectalis damage during transperineal ultrasound-guided biopsies and therapies.

Main Methods:

• Dissection of ten formalin-fixed male cadavers to examine puborectalis structure and its relation to peripheral organs.
• Observation of the puborectalis in a fresh male cadaver using transrectal ultrasound.
• Localization, anatomical confirmation, and thickness measurement of the puborectalis via transrectal sonography.

Main Results:

• Transrectal ultrasound observations of the puborectalis location were confirmed by anatomical examination in the fresh cadaver.
• Bilateral, symmetrical, hypoechoic strips adjacent to the prostate were visualized in cross-section, with fibers seen longitudinally.
• Mean puborectalis thickness measured 6.1-6.2 mm sonographically and 5.85-5.89 mm in the dissected cadaver.

Conclusions:

• Transrectal ultrasound offers a novel imaging modality for visualizing the male puborectalis.
• This technique establishes a basis for future recognition of pelvic floor abnormalities using ultrasonography.
• Accurate visualization of the puborectalis can improve safety in urological interventions.