A mathematical model for micturition gives new insights into pressure measurement and function

Our objective was to analyze the factors contributing to the development of detrusor pressure during micturition in the female with reference to a mathematical model. One hundred patients with predominantly stress incontinence were investigated with micturition pressure studies. Frictional and dynamic losses were estimated at various flow rates using a mathematical model. Almost 25% of patients recorded a micturition pressure below 11 cmH2O at peak flow (mean 23 cmH2O, range 0-91). Large inter- and intrapatient variations in micturition pressures were recorded on retesting. The low pressures were explained by a recently described external opening mechanism, backward stretching of the vagina during micturition by the muscles of the pelvic floor. This opened out the outflow tract and created the potential for a falsely high P(abd). The large variability in micturition pressures on retesting was attributed to changes in urethral radius being magnified to the fourth power. It was concluded that, micturition itself, and the components for pressure generation, are complex non-linear entities which appear to be greatly modified by the external striated pelvic floor opening mechanism. Addressing anatomical defects in this mechanism may be a fruitful route of future enquiry in females with emptying problems.