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The urethra is a hollowed tubular organ through which urine is expelled from the body. This structure extends from the bladder to the external opening, allowing urine to be released.
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The lower urinary system consists of the urinary bladder and urethra, which are essential in storing and expelling urine from the body. Together with the internal and external sphincters, these structures work together to regulate urination effectively.Anatomy of the BladderThe urinary bladder is a muscular, stretchable organ behind the pubic bone and in front of the rectum. In females, the bladder is positioned anterior to the vagina and inferior to the uterus, while in males, it is located...
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Comparing urethral closure mechanisms.

Peter Petros1

  • 1University of Western Australia School of Engineering and Mathematical Sciences, Perth, Australia.

Central European Journal of Urology
|August 8, 2022
PubMed
Summary

Understanding urethral closure is key for treating stress urinary incontinence. This study challenges pressure transmission theories, suggesting a musculo-elastic mechanism involving specific muscles and ligaments is more accurate for closure.

Keywords:
Integral Theorymidure-thral sling surgerypressure transmission theorypubourethralurethral closure

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Area of Science:

  • Urogynecology
  • Anatomy
  • Physiology

Background:

  • The precise mechanisms of urethral closure are debated, impacting the understanding and treatment of stress urinary incontinence (SUI).
  • Current theories include Enhorning's pressure transmission theory and musculo-elastic closure.
  • A clear grasp of urethral closure anatomy is essential for surgical success and complication management in SUI.

Purpose of the Study:

  • To critically evaluate dominant theories of urethral closure.
  • To elucidate the functional anatomy involved in maintaining urethral closure and its relation to micturition.

Main Methods:

  • Theoretical analysis of existing hypotheses on urethral closure.
  • Physiological reasoning based on observed responses to increased intra-abdominal pressure during straining.

Main Results:

  • The pressure transmission theory fails to explain why increased intra-abdominal pressure does not inhibit micturition during straining.
  • Straining actually increases urine flow, indicating a relaxation of the pubococcygeus muscle.
  • This relaxation facilitates the opening of the urethra by the levator plate/longitudinal anal muscle complex prior to micturition.

Conclusions:

  • The musculo-elastic closure mechanism, reliant on suspensory ligaments, provides a more plausible explanation for urethral closure than pressure transmission.
  • The interplay between specific muscles, like the pubococcygeus and levator ani complex, dictates urethral state during increased intra-abdominal pressure.