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Mechanisms of urethral continence and their clinical application

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Summary

Controversy about the basic nature of urethral function does not preclude accurate clinical assessment of disorders of function. While the precise method of treatment of urethral continence dysfunction varies from institution to institution, the basic techniques are quite similar. It is the application of a treatment method to a particular case which causes difficulty. It is important, therefore, to have some understanding of the functional elements in the urethral continence mechanism to be able to determine which element does not function. Most cases of intractable incontinence are associated with poor function of the involuntary part of the sphincter. In general, peak urethral closing pressures are unrelated to continence function unless there is no pressure at all.

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References

  1. Elliot TR (1907) The innervation of the bladder and urethra. J Physiol 25:367

    Google Scholar 

  2. Von Ziessl M (1983) Über die Innervation der Blase. Pflügers Arch Physiol 53:560

    Google Scholar 

  3. Barrington FJF (1914) The physiology of micturition. Q J Exp Physiol 8:33

    Google Scholar 

  4. Langworthy OR, Drew JE, Vest SA (1940) Urethral resistance in relation to vesical activity. J Urol 43:123

    Google Scholar 

  5. Wesson MB (1920) Anatomical embryological and physiological studies of the trigone and neck of the bladder. J Urol 34:279

    Google Scholar 

  6. Woodburne RT (1968) Anatomy of the bladder and bladder outlet. J Urol 100:474

    Google Scholar 

  7. Hutch JA (1967) A new theory of the anatomy of the internal urinary sphincter and the physiology of micturition. IV. The urinary sphincteric mechanism. J Urol 97:705

    Google Scholar 

  8. Tanagho EA (1971) Interpretation of the physiology in micturition. In: Hinman F (ed) Hydrodynamics of micturition. Thomas, Springfield, Ill, p 18

    Google Scholar 

  9. Tanagho EA, Meyers FH, Smith DR (1969) Urethral resistance: its components and implications. I. Smooth muscle component. Invest Urol 7:195

    Google Scholar 

  10. Tanagho EA, Meyers FH, Smith DR (1969) Urethral resistance: its components and implications. II. Skeletal muscle component. Invest Urol 7:195

    Google Scholar 

  11. Wear JB (1973) The neurogenic bladder. In: Karafin L, Kendall AR (eds) Urology. Harper & Row, New York

    Google Scholar 

  12. Lapides J, Sweet RB, Lewis LW (1957) Role of striated muscle in urination. J Urol 77:247

    Google Scholar 

  13. Brindley GS, Rushton DN, Craggs MD (1974) The pressure exerted by the external sphincter of the urethra when its motor nerve fibers are stimulated electrically. Br J Urol 46:453

    Google Scholar 

  14. Abrams P (1982) Urodynamic investigations. Monogr Urol 3:3

    Google Scholar 

  15. Gosling J (1979) The structure of the bladder and urethra in relation to function. Urol Clin North Am 6:31

    Google Scholar 

  16. Hamberger B, Norberg KA (1965) Adrenergic synaptic terminals and nerve cells in the bladder of the cat. Int J Neuropharmacol 4:41

    Google Scholar 

  17. Elbadawi A, Schenk EA (1974) A new theory of the innervation of the bladder musculature. III. Innervation of vesicourethral junction and external urethral sphincter. J Urol 111:613

    Google Scholar 

  18. Gjone R (1965) A dual peripheral and supra-spinal autonomic influence on the urinary bladder. J Oslo City Hosp 15:173

    Google Scholar 

  19. Edvardsen P (1968) Nervous control of the urinary bladder in cats. I. The collecting phase. Acta Physiol Scand 72:157

    Google Scholar 

  20. Kleeman FJ (1970) The physiology of the internal urinary sphincter. J Urol 104:549

    Google Scholar 

  21. Learmonth JR (1931) A contribution to the neurophysiology of the urinary bladder in man. Brain 54, pt 1,2

  22. Raz S, Caine M (1972) Adrenergic receptors in the female canine urethra. Invest Urol 9:319

    Google Scholar 

  23. Nergardh A, Boreus LO (1973) The functional role of cholinergic receptors in the outlet region of the urinary bladder: an in vitro study in the cat. Acta Pharmacol Toxicol 32:467

    Google Scholar 

  24. Raezer DM, Wein AJ, Jacobowitz D, Corriere JN Jr (1973) Autonomic innervation of canine urinary bladder: cholinergic and adrenergic contributions and interaction of sympathetic and parasympathetic systems in bladder function. Urology 2:211

    Google Scholar 

  25. DeGroat WC, Saum WR (1976) Synaptic transmission in parasympathetic ganglia in the urinary bladder of the cat. J Physiol 256:137

    Google Scholar 

  26. Saum WR, DeGroat WC (1972) Parasympathetic ganglia: activation of an adrenergic inhibitory mechanism by cholinomimetic agents. Science 175:659

    Google Scholar 

  27. Donker PJ, Ivanovici F, Nooch EL (1972) Analyses of the urethra pressure profile by means of electromyography and the administration of drugs. Br J Urol 44:180

    Google Scholar 

  28. Drahn HP, Morales PA (1965) The effect of pudendal nerve anesthesia on urinary continence after prostatectomy. J Urol 94:282

    Google Scholar 

  29. Nemoy NJ, Govan DE (1969) Urinary continence in the absence of an intact external sphincter. J Urol 102:200

    Google Scholar 

  30. Calapinto V, McCallum RW (1976) Urinary continence after repair of membranous urethral stricture in prostatectomized patients. J Urol 115:392

    Google Scholar 

  31. Krane RJ, Olsson CA (1973) Phenoxybenzamine in neurogenic bladder dysfunction. II. Clinical considerations. J Urol 110:653

    Google Scholar 

  32. Awad SA, Downie JW (1976) The effect of adrenergic drugs and hypogastric nerve stimulation on the canine urethra: a radiographic and urethral pressure study. Invest Urol 13:298

    Google Scholar 

  33. McGuire EJ (1977) Urethral closing pressure after spinal cord injury and its relationship to automatic dysreflexia. Urol Int 32:97

    Google Scholar 

  34. Caine M (1975) Some clinical implications of adrenergic receptors in the urinary tract. Arch Surg 110:247

    Google Scholar 

  35. McGuire EJ, Wagner F, Weiss RM (1976) Treatment of autonomic dysreflexia with Phenoxybenzamine. J Urol 115:53

    Google Scholar 

  36. Caine M, Pfau A, Perlberg S (1976) The use of adrenergic blockers in benign prostatic obstruction. Br J Urol 48:255

    Google Scholar 

  37. McGuire EJ (1975) Urodynamic evaluation after abdominal perineal resection or lumbar intervertebral disc herniation. Urology 6:63

    Google Scholar 

  38. Woodside JR, McGuire EJ (1979) Urethral hypotonicity following suprasacral spinal cord injury. J Urol 121:783

    Google Scholar 

  39. McGuire EJ, Wagner F (1977) The effects of sacral denervation on bladder and urethral function. Surg Gynecol Obstet 114:343

    Google Scholar 

  40. McGuire EJ, Herlihy E (1977) The influence of urethral position on urinary continence. Invest Urol 15:205

    Google Scholar 

  41. McGuire EJ, Herlihy E (1978) Bladder and urethral response to isolated sacral motor root stimulation. Invest Urol 16:219

    Google Scholar 

  42. Tanagho EA (1979) Membrane and microtransducer catheters: their effectiveness for profilometry of the lower urinary tract. Urol Clin North Am 6:110

    Google Scholar 

  43. Tanagho EA, Jonas U (1977) Membrane catheter: effective for recording pressures in the lower urinary tract. Urology 10:173

    Google Scholar 

  44. McGuire EJ, Lytton B, Pepe V, Kohorn EI (1976) Stress urinary incontinence. Obstet Gynecol 47:255

    Google Scholar 

  45. McGuire EJ, Woodside JR, Bordon TA, Weiss RM (1981) Prognostic value of urodynamic testing in myelodysplasia. J Urol 126:205

    Google Scholar 

  46. Leach GE, Raz S (1984) Management of complicated sphincteric incontinence: silicone gel prosthesis. In: Barrett DM, Wein AJ (eds) Controversies in neurourology. Churchill Livingstone. New York, p 377

    Google Scholar 

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  1. Section of Urology, Department of Surgery, University of Michigan Medical Center, 48109, Ann Arbor, Michigan, USA

    Edward J. McGuire

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  1. Edward J. McGuire
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McGuire, E.J. Mechanisms of urethral continence and their clinical application. World J Urol 2, 272–279 (1984). https://doi.org/10.1007/BF00326702

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