Advertisement

The Mechanism of Continence

  • Paul Hilton

Abstract

Urinary incontinence may be defined as “a condition in which involuntary loss of urine is a social or hygienic problem, and is objectively demonstrable” (Bates et al. 1983). Continence then, by inference, might be considered as the ability to retain urine within the bladder, between episodes of voluntary micturition. In order to comprehend fully the pathological processes which lead to the development of urinary incontinence, a clear understanding of the normal mechanisms for the maintenance of continence is of course fundamental; this in turn must be based on a knowledge of the development, anatomy, and physiology of the bladder and urethra, and their supporting structures. This chapter aims to provide this background information.

Keywords

Pelvic Floor Bladder Neck Urethral Pressure Maximum Urethral Closure Pressure Intravesical Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Anderson JT, Bradley WE, Timm GW (1976) The urethral electromyographic and gas pressure profile. Scand J Urol Nephrol 10: 185–188Google Scholar
  2. Anderson RS (1984) A neurogenic element to urinary genuine stress incontinence. Br J Obstet Gynaecol 91: 41–46PubMedCrossRefGoogle Scholar
  3. Asmussen M, Ulmsten U (1976) Simultaneous urethrocystometry by a new technique. Scand J Urol Nephrol 10: 7–11PubMedCrossRefGoogle Scholar
  4. Barnes AC (1940) A method for evaluating the stress of urinary incontinence. Am J Obstet Gynecol 40: 381–390Google Scholar
  5. Bates CP, Bradley WE, Glen E et al. (1983) Standardisation of terminology of lower urinary tract function. Collation of the first 4 reports by the Standardisation Committee of the International Continence SocietyGoogle Scholar
  6. Benson GS, McConnell JA, Wood JG (1979) Adrenergic innervation of the human bladder body. J Urol 122: 189–191PubMedGoogle Scholar
  7. Bottaccini MR, Gleason DM, Byrne JC (1973) Resistance measurement in the human urethra. In: Lutzeyer, Melchior (eds) Urodynamics. Springer, Berlin Heidelberg New York, pp 302–316Google Scholar
  8. Bradley WE, Timm TW, Scott FB (1974) Innervation of the detrusor muscle and urethra. Urol Clin North Am 1: 3–2 7Google Scholar
  9. Bunne G, Obrink A (1978a) Urethral closure pressure with stress. A comparison between stress incontinent and continent women. Urol Res 6: 127–134Google Scholar
  10. Bunne G, Obrink A (1978b) The influence of pubococcygeal repair on urethral closure pressure at stress. Acta Obstet Gynecol Scand 57: 355–359PubMedCrossRefGoogle Scholar
  11. Constantinou CE, Faysal MH, Govan DE (1980) The impact of bladder neck suspension on the mode of distribution of abdominal pressure along the female urethra. In: Proceedings of 10th International Continence Society Meeting, Los AngelesGoogle Scholar
  12. Denny-Brown D, Robertson EG (1933) On the physiology of micturition. Brain 56: 149–190CrossRefGoogle Scholar
  13. Donker PJ, Droes JThPM, van Ulden BM (1976) Anatomy of the musculature and innervation of the bladder and urethra. In: Williams DI, Chisholm GD (eds) Scientific foundations of urology. Heinemann, London, p 32Google Scholar
  14. Dundas D, Hilton P, Williams JE, Stanton SL (1982) Aetiology of voiding difficulties following colposuspension. 12th International Continence Society Meeting, Leiden, p 132Google Scholar
  15. Ek A, Alm P, Anderson KE, Persson CGA (1977) Adrenergic and cholinergic nerves in the human urethra and urinary bladder. A histochemical study. Acta Physiol Scand 90: 345–352Google Scholar
  16. Enhorning G (1961) Simultaneous recording of the intravesical and intraurethral pressure. Acta Chir Scand [Suppl] 276: 1–68Google Scholar
  17. Enhorning G (1976) A concept of urinary continence. Urol Int 31: 3–5PubMedCrossRefGoogle Scholar
  18. Fletcher TF, Bradley WE (1978) Neuroanatomy of the bladder-urethra. J Urol 119: 153–160PubMedGoogle Scholar
  19. Gosling JA (1979) The structure of the bladder and urethra in relation to function. Urol Clin North Am 6: 31–38PubMedGoogle Scholar
  20. Gosling JA, Dixon J (1979) Light and electronmicroscopic observations on the human external urethral sphincter. J Anat 129: 216Google Scholar
  21. Gosling JA, Dixon JS, Critchley HOD, Thompson SA (1981) A comparative study of human external sphincter and periurethral levator ani muscle. Br J Urol 53: 35–41PubMedCrossRefGoogle Scholar
  22. Gosling JA, Dixon JS, Humpherson JR (1983) Functional anatomy of the urinary tract. Churchill Livingstone, LondonGoogle Scholar
  23. Gosling JA, Dixon JS, Lendon RG (1977) The autonomic innervation of the human male and female bladder neck and proximal urethra. J Urol 118: 302–305PubMedGoogle Scholar
  24. Green TH (1980) Vaginal repair. In: Stanton SL, Tanagho EA (eds) Surgery of female incontinence. Springer, Berlin Heidelberg New York, pp 31–46Google Scholar
  25. Griffiths DJ (1980) Urodynamics. Adam Hilger, BristolGoogle Scholar
  26. Heidler H, Wolk H, Jonas U (1979) Urethral closure mechanism under stress conditions. Eur Urol 5: 110–112PubMedGoogle Scholar
  27. Henriksson L, Ulmsten U (1978) A urodynamic evaluation of the effects of abdominal urethrocystopexy and vaginal sling urethroplasty in women with stress incontinence. Am J Obstet Gynecol 113: 78–82Google Scholar
  28. Henriksson L, Ulmsten U, Anderson KE (1977) The effects of posture on the urethral closure pressure in healthy women. Scand J Urol Nephrol 11: 201–206PubMedCrossRefGoogle Scholar
  29. Hertogs K, Stanton SL (1983) The mechanism of successful colposuspension: a new model. In: Proceedings of the 13th International Continence Society Meeting, AachenGoogle Scholar
  30. Hilton P (1981) Urethral pressure measurement by microtransducer: observations on methodology, the pathophysiology of genuine stress incontinence, and the effects of its treatment in the female. MD Thesis, Newcastle upon TyneGoogle Scholar
  31. Hilton P (1983) Urethral pressure measurement on stress: a comparison on profiles on coughing and straining. Neurourol Urodynamics 2: 55–62CrossRefGoogle Scholar
  32. Hilton P, Stanton SL (1981) The urodynamic effects of successful and failed incontinence surgery. In: Proceedings of the International Urogynaecologists’ Association Meeting, StockholmGoogle Scholar
  33. Hilton P, Stanton SL (1983a) Urethral pressure measurement by microtransducer: the results in symptom-free women and in those with genuine stress incontinence. Br J Obstet Gynaecol 90: 919–934PubMedCrossRefGoogle Scholar
  34. Hilton P, Stanton SL (1983b) A clinical and urodynamic assessment of the Burch colposuspension for genuine stress incontinence. Br J Obstet Gynaecol 90: 934–939PubMedCrossRefGoogle Scholar
  35. Hilton P, Stanton SL (1983c) A clinical and urodynamic evaluation of the polypropylene ( Marlex) sling for genuine stress incontinence. Neurourol Urodynamics 2: 145–153Google Scholar
  36. Hilton P, Varma TR (1984) The menopause. In: Stanton SL (ed) Clinical gynecologic urology. C. V. Mosby, St. Louis, MissouriGoogle Scholar
  37. Huisman AB (1979) Morphologie vande Vrouwelijke Urethra. MD Thesis, Groningen, NetherlandsGoogle Scholar
  38. Hutch JA (1965) A new theory of the anatomy of the internal urethral sphincter and physiology of micturition. Invest Urol 3: 36–58PubMedGoogle Scholar
  39. Hutch JA (1971) The internal urethral urinary sphincter. A double loop system. J Urol 105: 375–383PubMedGoogle Scholar
  40. Karlson S (1953) Experimental studies on the functioning of the female urinary bladder and urethra. Acta Obstet Gynecol Scand 32: 285–307PubMedCrossRefGoogle Scholar
  41. Kluck P (1980) The autonomic innervation of the human urinary bladder, bladder neck and urethra. A histochemical study. Anat Rec 198: 439–447PubMedCrossRefGoogle Scholar
  42. Kuru M (1965) Nervous control of micturition. Physiol Review 44: 425Google Scholar
  43. Langreder W (1956) Die weibliche Urethra; funktionelle Anatomie Pathologie and Therapie des Verschlussmechanismus. Zentralbl fur Gynakol 78: 651–759Google Scholar
  44. Lapides J (1958) Structure and function of the internal vesical sphincter. J Urol 80: 341–353PubMedGoogle Scholar
  45. Lapides J, Sweet R, Lewis LW (1957) Role of striated muscle in urination. J Urol 77: 247–250PubMedGoogle Scholar
  46. Obrink A, Bunne G (1978) The margin to incontinence after three types of operation for stress incontinence. Scand J Urol Nephrol 12: 209–214PubMedCrossRefGoogle Scholar
  47. Obrink A, Bunne G, Ulmsten U, Ingleman-Sundberg A (1978) The urethral pressure profile before, during and after the pubococcygeal repair for stress incontinence. Acta Obstet Gynecol Scand 57: 49–61PubMedCrossRefGoogle Scholar
  48. Plevnik S, Vrtacnik P (1981) How to measure urethral softness? In: Zinner N, Sterling A (eds) Female incontinence. Alan R. Liss, New York, pp 253–258Google Scholar
  49. Rud T (1980) The urethral pressure profile in continent women from childhood to old age. Acta Obstet Gynecol Scand 59: 331–335PubMedCrossRefGoogle Scholar
  50. Rud T (1981) The striated pelvic floor muscles and their importance in maintaining urinary continence. In: Zinner N, Sterling A (eds) Female incontinence. Alan R. Liss, New York, pp 105–112Google Scholar
  51. Rud T, Anderson KE, Asmussen M, Hunting A, Ulmsten U (1980) Factors maintaining intraurethral pressure in women. Invest Urol 17: 343–347PubMedGoogle Scholar
  52. Smith P (1972) Age changes in the female urethra. Br J Urol 44: 667–676PubMedCrossRefGoogle Scholar
  53. Stanton SL (1978) Surgery for urinary incontinence. Clin Obstet Gynaecol 5.1: 83–108Google Scholar
  54. Stanton SL, Cardozo LD (1979) A comparison of vaginal and suprapubic surgery for the correction of incontinence due to urethral sphincter incompetence. Br J Urol 50: 497–499CrossRefGoogle Scholar
  55. Tanagho EA (1984) Thoughts on the neurophysiology of micturition. Today’s Therapeutic Trends 2: 65–70Google Scholar
  56. Tanagho EA, Pugh RCB (1963) Anatomy and function of the ureterovesical junction. Br J Urol 35: 151–165PubMedCrossRefGoogle Scholar
  57. Tanagho EA, Smith DR (1966) Anatomy and function of the bladder neck. Br J Urol 38: 54–71PubMedCrossRefGoogle Scholar
  58. Tanagho EA, Myers FH, Smith DR (1969a) Urethral resistance. Its components and implications. I. Smooth muscle components. Invest Urol 7: 136–149Google Scholar
  59. Tanagho EA, Myers FH, Smith DR (1969b) Urethral resistance. Its components and implications. II. Striated muscle components. Invest Urol 7: 195–205Google Scholar
  60. Tanagho EA, Miller ER (1970) Initiation of voiding. Br J Urol 42: 175–183PubMedCrossRefGoogle Scholar
  61. Torrens M (1976) Urethral sphincter responses to stimulation of sacral nerves in the human female. Proceedings of the 6th International Continence Society Meeting, AntwerpGoogle Scholar
  62. Torrens M (1984) Neurophysiology. In: Stanton SL (ed) Clinical gynecologic urology. C. V. Mosby, St. Louis, MissouriGoogle Scholar
  63. Turner-Warwick R (1984) A urodynamic view of the principles of female urinary incontinence procedures. In: Proceedings of the Royal College of Surgeons in Ireland Bicentenary Symposium, DublinGoogle Scholar
  64. van Mastrigt R, Coolsaet BLRA, van Duyl WA (1978) Passive properties of the urinary bladder in the collection phase. Med Biol Eng Comput 16: 471–482PubMedCrossRefGoogle Scholar
  65. Weil A, Reyes, H, Bischoff P, Rottenberg RD, Krauer F (1984) Modifications of the urethral resting and stress profiles after different types of surgery for urinary stress incontinence. Br Obstet Gynaecol 91: 46–5 5Google Scholar
  66. Wilson PD, Dixon JS, Brown ADG, Gosling JA (1979) A study of the pubourethral ligament in normal and incontinent women. Proceedings of the 9th International Continence Society Meeting, RomeGoogle Scholar
  67. Yeates WK (1972) Disorders of bladder function. Ann R Coll Surg Eng150: 335–353Google Scholar
  68. Zacharin RF (1963) The suspensory mechanism of the female urethra. J Anat 97: 423–427PubMedGoogle Scholar
  69. Zinner NR, Ritter RC, Sterling AM (1976) The mechanism of micturition. In: Williams DI, Chisholm GD (eds) Scientific foundations of urology. Heinemann, London, pp 39–51Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • Paul Hilton

There are no affiliations available

Personalised recommendations