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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...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Polish Urological Association
2022
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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 |
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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 |