Functional Anatomy of the Female Lower Urinary Tract and Pelvic Floor

DeLancey, John O.L.

doi:10.1002/9780470513941.ch4

Cited by 18 publications

(17 citation statements)

References 27 publications

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“…Women urethral anatomy has been described by DeLancey et al Our study demonstrate that tissular composition of rat urethra present several similarities to women's urethra. For example, variation in tissular composition along the urethra, with a complex striated urethral sphincter that includes belt‐like fibers in the middle of the urethra, and a distal portion devoid of longitudinal and circular smooth muscles.…”

Section: Discussionsupporting

confidence: 68%

Urethral regions with differential tissular composition may underlie urinary continence and voiding function in female rats

Mirto-Aguilar

Palacios-Galicia

Muñoz

et al. 2019

Neurourology and Urodynamics

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Aims To analyze, in female rats, the anatomical and histological features of the urethra and its relationship with the vagina and clitoris, and its innervation. Methods Seventeen adult female Wistar rats were used. Gross anatomy and acetylcholinesterase (AchE) histochemistry were performed to describe the urethral features, adjacent structures, and innervation. The histomorphometric characteristics of the urethra were determined in transversal, longitudinal, or coronal sections stained with Masson's Trichrome. Results The female rat urethra is not a homogeneous tubular organ. The pre‐pelvic and pelvic regions are firmly attached to the vagina with belt‐like striated fibers forming a urethra‐vaginal complex. The bulbar regions have curved segments and a narrow lumen. The clitoral region is characterized by a urethra‐clitoral complex surrounded by a vascular plexus. The lumen area and thickness of the urethral layers significantly varied between regions (P < 0.05). Innervation of the urethra arrives from the major pelvic ganglion, the dorsal nerve of the clitoris (DNC), and the motor branch of the sacral plexus (MBSP). Conclusions Differential tissular composition of the urethra may underlie urinary continence and voiding dysfunction through different physiological mechanisms. The urethra‐vagina complex seems to be the main site controlling urinary continence through active muscular mechanisms, while the bulbar urethra provides passive mechanisms and the urethra‐clitoris complex seems to be crucial for distal urethral closure by means of a periurethral vascular network.

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Section: Discussionsupporting

confidence: 68%

Urethral regions with differential tissular composition may underlie urinary continence and voiding function in female rats

Mirto-Aguilar

Palacios-Galicia

Muñoz

et al. 2019

Neurourology and Urodynamics

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“…Mechanical closure/integrity of the urethra is also necessary to prevent SUI and requires a healthy urethral epithelium and vascular plexus, as well as effective surrounding musculature; damage to any of these components can contribute to SUI by way of intrinsic sphincter deficiency. [3][4][5] The conclusions drawn from studies conducted on the sexual consequences of PFDs vary considerably. This variability can be attributed to the fact that the populations studied-and the methodology and type of questionnaires used-were different between the studies, rendering any pertinent analysis of the literature difficult.…”

Section: Introductionmentioning

confidence: 96%

Stress urinary incontinence and LUTS in women—effects on sexual function

2014

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The sexual impact of urinary incontinence in women depends on a host of parameters, including physical, psychological, social and cultural dimensions. Evaluation of the effects of stress urinary incontinence (SUI) and lower urinary tract symptoms on sexual function is often biased by their common association with other pelvic floor disorders, such as pelvic organ prolapse, which also affect sexual satisfaction. Indeed, these complexities are reflected in the literature, which shows considerable disparity in sexual functional characteristics in women with incontinence both before and after treatment. This discordance is further emphasized by heterogeneity in study design, quality and analysis. Here, we describe the nature of sexual dysfunction in women with incontinence, including coital incontinence. The various treatments for SUI, which include transvaginal tape surgeries, can also affect sexual function, positively or negatively. Coital incontinence seems to be a good predictor of an improvement in postoperative sexual parameters: its cure, achieved by >90% of women, to a large extent explains the sexual benefits reported in several studies. By contrast, deterioration in sexual function is sometimes reported after surgery, with de novo or worsened dyspareunia being the most common cause. The literature does not contain any convincing arguments for one treatment or another on the basis of sexual functional outcome.

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“…The proximal part of the urethra is intra-abdominal and is linked to the pubic bone [1]. The portion may have some functional importance, in that changes of intraabdominal pressure might compress the proximal urethra directly, and so give a slightly increased resistance to counteract the concurrent increase in intra-vesical pressure.…”

Section: Normal Continence Mechanismsmentioning

confidence: 99%

Classification of stress urinary incontinence

2015

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While SUI classification is potentially relevant to treatment selection, evidence for influence on management outcome is limited. Generating a high-quality evidence base for treatment selection on these criteria is problematic, particularly due to the range of confounding factors. In practice, the modern practitioner relies on various tools to form an opinion on some key aspects, using the findings to derive a treatment strategy. Accordingly, there remains a need to confirm how a classification of SUI translates into treatment selection and better outcomes.

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Functional Anatomy of the Female Lower Urinary Tract and Pelvic Floor

Cited by 18 publications

References 27 publications

Urethral regions with differential tissular composition may underlie urinary continence and voiding function in female rats

Urethral regions with differential tissular composition may underlie urinary continence and voiding function in female rats

Stress urinary incontinence and LUTS in women—effects on sexual function

Classification of stress urinary incontinence

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