The prostatic urethra and distal sphincteric complex are often overlooked compartments that influence symptoms, treatment response, and uncommon complications of benign prostatic hyperplasia (BPH). Emerging anatomical studies suggest that the prostatic urethra is a dynamic structure where differences in length, curvature, and angulation alter local hydrodynamics and contribute to symptoms inadequately predicted by prostate volume alone. Real-time imaging further suggests that the periverumontanal region is responsible for creating an antichamber in which semen accumulates and directs antegrade flow. Therefore, anatomical distortion, surgical modification, or local physiological barriers disruption in this region may alter ejaculatory mechanics or permit reflux phenomena involving urine or seminal fluid. Distal to this region, the external urethral sphincter may present anterior and lateral extensions beyond conventional landmarks. These considerations should be studied when planning obstructive surgery and may help explain atypical continence patterns, pelvic discomfort, or dysorgasmia not captured by conventional lower urinary tract symptoms. PATIENT SUMMARY: We reviewed anatomical features of the prostatic urethra and sphincter, which are usually overlooked in standard evaluation of benign prostatic hyperplasia. Recognizing such anatomic variants may help explain unusual symptoms and improve surgical treatment.
European urology focus. 2026 Jun 20 [Epub ahead of print]
Marco Finati, Alessandro Uleri, Melissa R Kaufman, Marcus J Drake, Benjamin Pradère
Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France; Department of Urology and Renal Transplantation, Policlinico Riuniti University Hospital, Foggia, Italy. Electronic address: ., Department of Urology, Josep Trueta University Hospital, Girona, Spain., Division of Reconstructive Urology and Pelvic Health, Vanderbilt Medical Center, Nashville, TN, USA., Department of Surgery and Cancer, Imperial College London, London, UK., Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France.