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Stress urinary incontinence: An alternative concept of pathogenesis

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Abstract

A urodynamic study was done on 14 normal subjects and 24 with stress urinary incontinence (SUI), aiming to elucidate SUI etiology. All were multiparous women; 8 of the SUI patients also had partial fecal incontinence. The investigations comprised measuring the vesical and urethral pressures before and after testing external urethral sphincter anesthesia, determination of the functional urethral length and recording of the external urethral sphincter EMG, the straining-urethral reflex and the perineal nerve terminal motor latency (PNTML). The results in both normal and SUI subjects showed that coughing caused both vesical and urethral pressure increase, while an increase in vesical pressure only on external urethral sphincter anesthesia. In SUI patients, the urethral pressure at rest and on coughing was significantly lower (P<0.001) and the functional length shorter than in normal subjects (P<0.01). The external urethral sphincter EMG activity was below normal. The latency of the straining-urethral reflex as well as the PNTML were longer than normal (P<0.01). Results suggest that urethral pressure increase on coughing is effected by external urethral sphincter contraction and is not transmitted by increased intraabdominal pressure, as evidenced by the urethral sphincter anesthesia test and physioanatomic studies. The vesical and urethral descent in SUI is likely to be related to levator subluxation and sagging, which causes levator dysfunction. The cause of the weak external urethral sphincter and the prolonged straining-urethral reflex latency seems to be neurogenic, due probably to stretch of the pudendal nerve in the pudendal canal, as evidenced by the prolonged PNTML.

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References

  1. Hadley HR, Zimmern PE, Raz S. The treatment of male urinary incontinence. In Walsh PC, Gittes RS, Perlmutter AD, Stamey TA, eds. Campbell's urology. 5th edn, vol. 3. Philadelphia: WB Saunders, 1986; pp. 2658–2679

    Google Scholar 

  2. Nordling J. Influence of the sympathetic nervous system on the lower urinary tract in man. Neurourol Urodyn 1983;2:3–7

    Google Scholar 

  3. Gosling JA, Dixon JS, Lendon RG. The anatomic innervation of the human male and female bladder neck and proximal urethra. J Urol 1977;118:302–305

    Google Scholar 

  4. Gosling JA, Dixon JS. The structure and innervation of the external urethral sphincter. Proceedings of the International Continence Society, Portoroz, 1977; pp. 117–119

  5. Tanagho EA, Schmidt RA, Gomes de Aranjo C. Urinary striated sphincter: what is its nerve supply? Urology 1982;20:415–417

    Google Scholar 

  6. Vodusek DB, Light JK. The motor nerve supply of the external urethral sphincter muscles: an electrophysiological study. Neurourol Urodyn 1983;2:193–198

    Google Scholar 

  7. Bailey KV. Clinical investigation into uterine prolapse with stress incontinence. J Obstet Gynecol 1956;63:663–676

    Google Scholar 

  8. Green TH. Development of a plan for the diagnosis and treatment of urinary stress incontinence. Am J Obstet Gynecol 1962;83:632–648

    Google Scholar 

  9. Frewen WK. Foley catheter urethrography in stress incontinence. J Obstet Gynecol 1971;78:660–663

    Google Scholar 

  10. McGuire E, Lytton E, Pepe V, Kohorn EI. Stress urinary incontinence. J Obstet Gynecol 1976;47:255–264

    Google Scholar 

  11. Hodgkinson CP. Stress urinary incontinence. Am J Obstet Gynecol 1970;108:1141–1168

    Google Scholar 

  12. Hutch JA. A new theory of the anatomy of the internal urinary sphincter and the physiology of micturition. V- The base plate and stress incontinence. Obstet Gynecol 1967;30:309–317

    Google Scholar 

  13. Enhorning G. Simultaneous recording of intraurethral and intravesical pressure. A study of urethral closure and stress incontinent women. Acta Chir Scand 1961;276: (Suppl.) 1–68

    Google Scholar 

  14. Lapides J. Stress incontinence. J Urol 1961;85:291–294

    Google Scholar 

  15. Bates CP, Loose H, Standton SLR. The objective study of incontinence after repair operations. Surg Gynecol Obstet 1973;136:17–22

    Google Scholar 

  16. Edwards L, Malvern J. The urethal pressure profile. Br J Urol 1974;46:3254–335

    Google Scholar 

  17. Gleason DM, Reilly RJ, Bottaccini MR et al. The urethral continence zone and its relation to stress incontinence. J Urol 1974;112:81–88

    Google Scholar 

  18. Snooks SJ, Swash M. Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence. Br J Urol 1984;56:401–405

    Google Scholar 

  19. Lose G, Colstrup H. Mechanical properties of the urethra in healthy and stress incontinent females: dynamic measurements in the resting urethra. J Urol 1990;144:1258–1262

    Google Scholar 

  20. Anderson RS. A neurogenic element to urinary genuine stress incontinence. Br J Obstet Gynaecol 1984;91:41–44

    Google Scholar 

  21. Smith ARB, Wanell DW. Denervation of the striated urethral sphincter in urinary incontinence of urine. Proc. ICS, 15th. Ann. Meet., London, 1985; pp. 44–45

  22. Massey A, Abrams P. Urodynamics of the female lower urinary tract. Urol Clin North Am 1985;12:231–236

    Google Scholar 

  23. Stamey TA. Endoscopic suspension of the vesical neck for urinary incontinence in females: report on 203 consecutive patients. Ann Surg 1980;192:465–471

    Google Scholar 

  24. Shafik A. Straining-urethral reflex: description of a reflex and its clinical significance. Acta Anat 1991;140:104–107

    Google Scholar 

  25. Snooks SJ, Swash M. Nerve stimulation techniques. In Henry MM, Swash M, eds. Coloproctology and the pelvic floor. Pathophysiology and management. London: Butterworths, 1985;pp. 112–128

    Google Scholar 

  26. Lund CJ, Fullerton RE, Tristan RA. Cinefluorographic studies of the bladder and urethra in women. Am J Obstet Gynecol 1959;78:796–708

    Google Scholar 

  27. Kitzmiller JL, Manzer GA, Nebel WA et al. Chain cystourethrogram and stress incontinence. Obstet Gynecol 1972;39:330–340

    Google Scholar 

  28. Warwick R, Williams PL. In Gray's Anatomy, 35th edn., Longman, 1975; p. 527–531

  29. Hutch JA, Rambo ON. A study of the autonomy of the prostate, prostatic urethra, and the urinary sphincter system. J Urol 1970;104:443–448

    Google Scholar 

  30. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. II- Anatomy of the levator ani muscle, with special reference to puborectalis. Invest Urol 1975;18:175–182

    Google Scholar 

  31. Shafik A, Olfat S. New physioanatomical aspects of the urinary sphincter apparatus and the micturition mechanism. II-Levator ani muscle: role in the mechanism of micturition. EMJ 1986;3:31–43

    Google Scholar 

  32. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VIII- Levator hiatus and tunnel: anatomy and function. Dis Colon Rectum 1979;22:539–549

    Google Scholar 

  33. Shafik A. Pelvic double-sphincter control complex. Theory of pelvic organ continence with clinical application. Urology 1984;23:611–618

    Google Scholar 

  34. Shafik A. Straining-levator reflex: the description of a new reflex and its clinical significance. Coloproctology 1991;13:314–319

    Google Scholar 

  35. Shafik A. Micturition and urinary continence: new concepts. Int Urogynecol J 1992;3:168–175

    Google Scholar 

  36. Shafik A. A concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Dis Colon Rectum 1987;30:970–982

    Google Scholar 

  37. Shafik A. Pudendal canal syndrome: description of a new syndrome and its treatment. Report of 7 cases. Coloproctology 1991;13:102–109

    Google Scholar 

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  1. Department of Surgery and Research, Faculty of Medicine, Cairo University, Cairo, Egypt

    A. Shafik

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Shafik, A. Stress urinary incontinence: An alternative concept of pathogenesis. Int Urogynecol J 5, 3–11 (1994). https://doi.org/10.1007/BF00451702

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