The Suspensory Apparatus of the Female Bladder Neck

Olesen, Knud H.; Grau, Viggo

doi:10.1159/000280029

Cited by 24 publications

(12 citation statements)

References 2 publications

(3 reference statements)

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“…The higher fiber density of the rhabdosphincter at the mid and distal urethra compared to the proximal part signifies the impact of periurethral muscles on the proximal area. From anatomical studies it is known that the levator ani muscle exerts this effect through its ligamentous attachments [34,35,38,40]. This is in accordance with physiological measurements [29,98] showing an almost identical impact of voluntary muscles at the proximal and midurethral segments.…”

Section: Anatomical Interpretations From Urethral Stress Relaxation Asupporting

confidence: 71%

“…The anatomy of the female urethra and bladder neck has been studied in great detail in relation to the urinary continence mechanism [34][35][36][37][38][39][40][41]. The structures forming the urethral tube are mainly composed of collagen fibers and smooth muscles, both of which are predominantly longitudinally arranged [37,[42][43][44].…”

Section: Anatomy and Physiologymentioning

confidence: 99%

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An analysis of urethral viscoelasticity with particular reference to the sphincter function in healthy women

Thind

1995

Int Urogynecol J

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Urine ingression into the urethra involves stretching of the fibers, resulting in a pressure increase. This study describes the pressure response following a rapid urethral dilatation. A probe for simultaneous recording of cross-sectional area (dilatation) and pressure was used. The urethral dilatations were induced by a gravitationally operated pump. Fifteen healthy women were studied. The pressure response (viscoelastic reaction) is a steep increase with the maximum at the end of dilatation. The maximum pressure is followed by a pressure decay (stress relaxation) over the next few seconds. The pressure response was highly dependent on the size and rate of dilatation but not on the urethral site of measurement. The median pressure response to a dilatation of 10 mm 2 at a rate of 150 mm2/s (chosen arbitrarily within the physiological range) is 45 cmH20. The pressure response may account for 25% of the urethral resistance to dilatation.

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Section: Anatomical Interpretations From Urethral Stress Relaxation Asupporting

confidence: 71%

Section: Anatomy and Physiologymentioning

confidence: 99%

An analysis of urethral viscoelasticity with particular reference to the sphincter function in healthy women

Thind

1995

Int Urogynecol J

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“…where Q, , , is the maximum velocity of CA reduction measured at the middle of the cylinder [Colstrup, 1985;V;VI]. The units are:…”

Section: Urethral Measurementsmentioning

confidence: 99%

“…indicating strong adjunctive closure forces throughout the urethra including the bladder neck. At this location the impact of the rhabdosphincter may be sparse; however, the pelvic floor is supposed to affect the bladder neck through tendinous connections [Bors et al, 1954;Zacharin, 1968;Olesen and Grau, 1976;DeLancey, 19911. The drugs used caused no significant effect on the contractility parameters. indicating that the clinically important adjunctive closure forces are unaffected by autonomic receptor stimulation or blockade.…”

Section: Drug Effectsmentioning

confidence: 99%

The significance of smooth and striated muscles in the sphincter function of the urethra in healthy women

Thind

1995

Neurourology and Urodynamics

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“…The precise anatomy-including the number, orientation, sites of attachment, and names of the urethral supporting ligaments-has not been elucidated fully, and to our knowledge there is currently no uniform opinion concerning these structures [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Specifically, whether the ligaments ventral to the urethra have a transverse [22,23] or anteroposterior [6,9,24] orientation and whether the ligaments dorsal to the urethra (whose names are uncertain) originate from the urethra itself [2,5] or from the anterior vaginal wall [3,4] are areas of disagreement.…”

mentioning

confidence: 99%

Anatomy of the Urethral Supporting Ligaments Defined by Dissection, Histology, and MRI of Female Cadavers and MRI of Healthy Nulliparous Women

Sayed

Morsy

Mashed

et al. 2007

American Journal of Roentgenology

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CMEThis article is available for CME credit. See www.arrs.org for more information.OBJECTIVE. There has been no uniformity of opinion concerning the structures supporting the female urethra. Therefore, the aims of this prospective study were to define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers.SUBJECTS AND METHODS. Dissection of seven formalin-preserved cadavers (age at death, 25-50 years; no parity history available) was performed by a professor of anatomy to explore the anatomy of the urethral supporting ligaments and was followed by MRI of the cadaveric specimens with ligamentous markers in place and then by histologic analysis of the dissected ligaments. MRI of 17 healthy nulliparous women (age range, 20-35 years; mean age, 25.5 years) was then performed using T2-weighted, dual turbo spin-echo, balanced fast-field echo, and STIR sequences. A standardized grid system that allowed us to record structural observations on sequentially numbered axial MR images was used by a radiologist who then applied a 4-point grading scale to assess ligament visibility. Three authors-one radiologist, one anatomist, and one urologist-then compared the appearance of each ligament seen in a cadaveric specimen with its appearance on MR images of the same cadaver and on MR images of volunteers.RESULTS. At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively.CONCLUSION. Our results present evidence that may help resolve previous controversies regarding the MR appearance of the ventral urethral ligaments and that better define the course of the ligament dorsal to the urethra, the suburethral ligament. We hope that this detailed anatomic information about the structures involved in continence may lead eventually to improvements in the treatments for women with stress urinary incontinence. F Downloaded from www.ajronline.org by 117.253.101.235 on 10/09/15 from IP address 117.253.101.235.

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The Suspensory Apparatus of the Female Bladder Neck

Cited by 24 publications

References 2 publications

An analysis of urethral viscoelasticity with particular reference to the sphincter function in healthy women

An analysis of urethral viscoelasticity with particular reference to the sphincter function in healthy women

The significance of smooth and striated muscles in the sphincter function of the urethra in healthy women

Anatomy of the Urethral Supporting Ligaments Defined by Dissection, Histology, and MRI of Female Cadavers and MRI of Healthy Nulliparous Women

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