The rectourethralis is a small band of smooth muscle in the male pelvis that runs forward from the outer longitudinal muscle of the rectum to the perineal body and the back of the membranous urethra. It lies in the narrow space between the rectum and the urethra, just below the prostate. It is best known as a surgical landmark rather than for any movement it produces.
| Origin | Anterior longitudinal smooth muscle layer of the rectum at the anorectal junction |
|---|---|
| Insertion | Perineal body and posterior aspect of the membranous urethra |
| Nerve Supply | Autonomic fibres from the inferior hypogastric (pelvic) plexus |
| Blood Supply | Middle and inferior rectal arteries |
| Actions |
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|---|
It acts mainly as a tether, linking the anorectal junction to the perineal body and urethra and helping keep these structures in their normal positions. It has no voluntary action.
The rectourethralis must be divided during radical perineal prostatectomy and some approaches to the membranous urethra, and it is a key landmark because the rectal wall lies immediately behind it. Dividing it too far posteriorly risks injury to the rectum and can lead to a rectourethral fistula. It is not palpable on examination and is identified at surgery or on detailed imaging.
An abnormal connection between the rectum and urethra that can follow surgical injury in the plane of the rectourethralis, for example during prostatectomy or pelvic radiotherapy, causing passage of urine through the rectum, air in the urine, and recurrent urinary infections.
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