Cargando…

Comparing urethral closure mechanisms

The ongoing debate in “International Urogynecology Journal” about urethral closure mechanisms is important, because without a clear understanding of the anatomy of closure and stress urinary incontinence, the surgeon can never understand how corrective surgery works, or how to systematically address...

Descripción completa

Detalles Bibliográficos
Autor principal: Petros, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Polish Urological Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326701/
https://www.ncbi.nlm.nih.gov/pubmed/35937660
http://dx.doi.org/10.5173/ceju.2022.0107
_version_ 1784757349630607360
author Petros, Peter
author_facet Petros, Peter
author_sort Petros, Peter
collection PubMed
description The ongoing debate in “International Urogynecology Journal” about urethral closure mechanisms is important, because without a clear understanding of the anatomy of closure and stress urinary incontinence, the surgeon can never understand how corrective surgery works, or how to systematically address complications of such operations. The two dominant mechanisms which explain urethral closure rely either on Enhorning’s ‘pressure transmission theory’, or musculo-elastic closure which relies on structurally sound suspensory ligaments. Pressure transmission hypotheses fail a simple test, “Why does the same raised intrabdominal pressure which ‘closes the urethra’ not stop micturition when the woman strains downwards?” Rather, it increases urine flow, a consequence of the relaxation of the forward closure muscle, pubococcygeus, which allows the posterior vectors levator plate/longitudinal muscle of the anus, to open out the urethra prior to micturition, while the raised pressure from straining drives the urine out faster.
format Online
Article
Text
id pubmed-9326701
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Polish Urological Association
record_format MEDLINE/PubMed
spelling pubmed-93267012022-08-04 Comparing urethral closure mechanisms Petros, Peter Cent European J Urol Short Communication The ongoing debate in “International Urogynecology Journal” about urethral closure mechanisms is important, because without a clear understanding of the anatomy of closure and stress urinary incontinence, the surgeon can never understand how corrective surgery works, or how to systematically address complications of such operations. The two dominant mechanisms which explain urethral closure rely either on Enhorning’s ‘pressure transmission theory’, or musculo-elastic closure which relies on structurally sound suspensory ligaments. Pressure transmission hypotheses fail a simple test, “Why does the same raised intrabdominal pressure which ‘closes the urethra’ not stop micturition when the woman strains downwards?” Rather, it increases urine flow, a consequence of the relaxation of the forward closure muscle, pubococcygeus, which allows the posterior vectors levator plate/longitudinal muscle of the anus, to open out the urethra prior to micturition, while the raised pressure from straining drives the urine out faster. Polish Urological Association 2022-06-29 2022 /pmc/articles/PMC9326701/ /pubmed/35937660 http://dx.doi.org/10.5173/ceju.2022.0107 Text en Copyright by Polish Urological Association https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
spellingShingle Short Communication
Petros, Peter
Comparing urethral closure mechanisms
title Comparing urethral closure mechanisms
title_full Comparing urethral closure mechanisms
title_fullStr Comparing urethral closure mechanisms
title_full_unstemmed Comparing urethral closure mechanisms
title_short Comparing urethral closure mechanisms
title_sort comparing urethral closure mechanisms
topic Short Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326701/
https://www.ncbi.nlm.nih.gov/pubmed/35937660
http://dx.doi.org/10.5173/ceju.2022.0107
work_keys_str_mv AT petrospeter comparingurethralclosuremechanisms